GIFT  OF 
Pacific   Coast 


PRACTICAL  BANDAGING 


INCLUDING 


ADHESIVE  AND   P^ASTER-OF-PARIS 
DRESSINGS  v ,;i\\ 


BY 

ELDRIDGE  L.  ELIASON,  A.B.,  M.D., 

ASSISTANT  INSTRUCTOR  IN  SURGERY  IN  THE  UNIVERSITY  OF  PENNSYLVANIA  MEDICAL  SCHOOL; 
ASSISTANT  SURGEON.  UNIVERSITY  OF  PENNSYLVANIA   HOSPITAL;   ASSISTANT   SURGEON, 

HOWARD  HOSPITAL;  MEMBER  OF  THE  COLLEGE  OF  PHYSICIANS  OF  PHILADELPHIA. 


155  ORIGINAL  DRAWINGS  AND  PHOTOGRAPHS 


PHILADELPHIA  AND  LONDON 
J.  B.  LIPPINCOTT  COMPANY 


GIFT  PACIFIC  COAST   JOURNAL 
OF   NURSING  TO  HYGEINE  DEPT. 


COPYRIGHT,  1914 
BY  J.  B.  LIPPINCOTT  COMPANY 


Electrotyped  and  Printed  by  J.  B.  Lippincott  Company 
The  Washington  Square  Press,  Philadelphia,  U.S.A. 


mouoor 


To 
PROF.  EDWARD  MARTIN,  A.M.,  M.D. 

TO    WHOSE     EXAMPLE,   AID    AND 
PRECEPT   THE   AUTHOR   OWES   MUCH 


743534 


PREFACE 

THIS  work  has  been  written  for  students  and  nurses,  and 
for  that  reason  has  been  made  as  simple  and  non-technical  as 
possible.  An  endeavor  has  been  made  to  clear  up  a  number 
of  points  in  the  application  of  bandages,  that  have  been  more 
or  less  indefinitely  presented  heretofore.  All  the  recognized 
classical  bandages  in  common  use  are  described.  In  addition, 
however,  the  author  has  added  paragraphs  or  illustrations 
of  methods  or  turns  which  have  been  found  more  efficient 
in  his  experience.  An  effort  has  been  made  to  have  the  illus- 
trations absolutely  correct  and  for  this  reason  all  the  draw- 
ings were  made  from  a  model  dressing. 

Some  of  the  illustrations  are  retained  as  photographs,  thus 
hoping  to  make  the  impression  more  realistic  and  lasting. 

Due  to  the  increasing  usage  of  gauze  bandage  the  plia- 
bility of  which  covers  a  multitude  of  sins,  there  is  a  tendency 
to  neglect  the  fundamental  principles  of  bandaging.  One 
should  remember  that  every  bandage  properly  applied  takes 
less  material,  retains  its  place  better  and  gives  a  much  better 
impression,  than  one  improperly  applied. 

One  chapter  is  given  up  to  the  miscellaneous  bandages  and 
dressings  and  includes  handkerchief  bandages,  cravats,  slings, 
swathes  and  various  especially  constructed  dressings  in  more 
or  less  common  use. 

A  short  chapter  handles  in  a  brief  manner  rubber  or 
elastic  bandages  and  their  substitutes. 

Chapter  IV  treats  in  detail  the  question  of  adhesive 
plasters,  describing  the  various  types,  their  storage,  applica- 
tion and  removal.  Illustrations  show  the  various  dressings 
employed. 


VI 


PREFACE 


The  last  chapter  discusses  plaster  of  Paris  in  all  its 
phases.  The  reader  is  shown  every  step  from  the  making  of 
the  individual  plaster  bandage  to  the  application  of  the  com- 
pleted dressing  in  its  many  forms  and  finally  its  removal. 

This  work  is  meant  merely  to  describe  the  various  dress- 
ings and  their  application.  No  attempt  has  been  made  to 
consider  the  indications  for  such  dressings. 

THE  AUTHOR. 
PHILADELPHIA,  JULY,  1914. 


CONTENTS 

PART  I 
ROLLER  BANDAGES  PAGK 

FUNDAMENTAL  FACTS t 

PREPARATION  OF  BANDAGES 2 

How  TO  ROLL  BANDAGES 3 

STARTING  BANDAGES 5 

REQUISITES  OF  A  BANDAGE 5 

ENDING  A  BANDAGE 6 

FUNDAMENTAL  TURNS  OR  BANDAGES 6 

SPIRAL  OF  FINGER 10 

SPIRAL  REVERSE  OF  THE  FINGER 10 

DEMIGAUNTLET  BANDAGES 12 

GAUNTLET  BANDAGE 12 

SPICA  OF  THE  THUMB 15 

SPIRAL  REVERSE  OF  UPPER  EXTREMITY 15 

SPICA  OF  THE  SHOULDER 16 

SPIRAL  REVERSE  OF  THE  LOWER  EXTREMITY 17 

SPIRAL  OF  THE  FOOT  COVERING  THE  HEEL 19 

SPICA  OF  THE  FOOT 21 

FlGURE-OF-8  OF  THE  LEG 22 

SPICA  OF  THE  GROIN 25 

DOUBLE  SPICA  OF  THE  GROIN 29 

CROSSED  BANDAGE  OF  THE  PERINEUM 31 

POSTERIOR  FiGURE-OF-8  OF  SHOULDERS  AND  BACK 33 

ANTERIOR  FIGURE-OF-S  OF  SHOULDERS  AND  CHEST 34 

SUSPENSORY  OF  THE  BREAST 34 

SUSPENSORY  OF  BREAST : 36 

SUSPENSORY  OF  BOTH  BREASTS 37 

FlGURE-OF-8  OF  THE  BREASTS  (KlWISCH) 38 

DESAULT 38 

DAVIS  BANDAGE 41 

VELPEAU  (MODIFIED) 42 

VELPEAU  MODIFIED  (DULLES) 46 

FlGURE-OF-8  OF  THE  HEAD  AND  NECK 47 

BARTON  BANDAGE 47 

GIBSON  BANDAGE 48 

OBLIQUE  OF  THE  JAW 49 

DOUBLE  OBLIQUE  OF  THE  JAW 50 

RECURRENT  OF  THE  SCALP 51 

vii 


CONTENTS 

TRANSVERSE  RECURRENT  OF  THE  SCALP.  . . : 52 

RECURRENT  OF  SCALP  WITH  DOUBLE  ROLLER 52 

MONOCLE  OR  CROSSED  BANDAGE  OF  ONE  EYE 53 

BINOCULAR  OR  CROSSED  BANDAGE  OF  BOTH  EYES 54 


PART  II 
MISCELLANEOUS  BANDAGES 

TAILED  BANDAGES 55 

PERINEAL  "  T  "  BANDAGE 55 

PERINEAL  BANDAGE  (CUNNINGHAM) 56 

THE  "  T  "  BANDAGE  OF  THE  SCALP 57 

THE  "  T  "  BANDAGE  OF  THE  EYE 57 

THE  "  T  "  BANDAGE  OF  THE  EAR 58 

THE  DOUBLE  "  T  "  OF  THE  CHEST 59 

THE  FOUR-TAILED  BANDAGE  OF  CHIN 60 

FOUR-TAILED  BANDAGE  OF  THE  NOSE  AND  UPPER  LIP 60 

QUADRANGLE  BANDAGE  OF  OCCIPUT 61 

QUADRANGLE  BANDAGE  OF  THE  VERTEX 61 

QUADRANGLE  BANDAGE  OF  NECK 61 

QUADRANGLE  BANDAGE  OR  SLING  OF  THE  SHOULDER 61 

QUADRANGLE  BANDAGE  OR  SLING  OF  ARM  AND  FOREARM 62 

MANY  TAILED  BANDAGES  (SCULTETUS) 63 

SWATHES 63 

HANDKERCHIEF  BANDAGES 65 

OCCIPITOFRONTAL  TRIANGLE 66 

FRONTO-OCCIPITAL  TRIANGLE 66 

BITEMPORAL  TRIANGLE 66 

VERTICOMENTAL  TRIANGLE 66 

AURICULO-OCCIPITAL  TRIANGLE 67 

THE  TRIANGLE  OF  THE  HEAD 67 

SQUARE  CAP  OF  THE  HEAD 68 

POSTERIOR  TRIANGLE  OF  SHOULDERS 70 

THE  THORACICOSCAPULAR  TRIANGLE 70 

THORACICOHUMERAL  TRIANGLE 71 

TRIANGLE  SUSPENSORY  OF  THE  BREASTS 71 

BRACHIOCERVICAL  TRIANGLE  (a) 71 

BRACHIOCERVICAL  TRIANGLE  (b) 72 

BRACHIOSCAPULAR  TRIANGLE  (a) 73 

BRACHIOSCAPULAR  TRIANGLE  (b) 73 

MAYOR'S  BANDAGE 74 

MODIFICATION  OF  MAYOR'S  BANDAGE 75 

SHOULDER  TRIANGLE 75 

HAND  TRIANGLE 76 

ANTERIOR  PELVIC  TRIANGLE 76 


CONTENTS  ix 

POSTERIOR  PELVIC  TRIANGLE 76 

SCROTAL  HAMMOCK 76 

SCROTAL  TRIANGLE 78 

SCROTAL  SQUARE 78 

GLUTEAL  TRIANGLE 78 

INGUINAL  TRIANGLE 78 

TlBIOCERVICAL  SLING 78 

KNEE  TRIANGLE 79 

FOOT  TRIANGLE 79 

CRAVATS 79 

PART  III 
ELASTIC  BANDAGES 

MARTIN'S  RUBBER  BANDAGE 80 

ELASTIC  WEBBING 81 

ESMARCH  TUBE  OR  TOURNIQUET 81 

ELASTIC  FABRIC  BANDAGE 81 

UNNA'S  DRESSING 81 

PART  IV 
ADHESIVE  DRESSINGS 

SURGEON'S  ADHESIVE  PLASTER 83 

"  ZO  "  ADHESIVE  PLASTER 83 

JANUS  ADHESIVE  PLASTER 83 

DE  LA  COUR'S  ADHESIVE  PLASTER 83 

ISINGLASS  PLASTER 84 

ABDOMEN 86 

UMBILICUS 87 

SHOULDER  (SAYRE  DRESSING) 88 

SAYRE  MODIFIED 89 

ACROMIOCLAVICULAR  JOINT 9O 

TAPED  ADHESIVE  (MONTGOMERY  STRAP) 92 

CATHETER  STRAPS 92 

DUMB-BELL  ADHESIVE  STRAP 92 

LACED  ADHESIVE 92 

SPLINTS 93 

FURUNCLE  CONE 93 

BACK 93 

STIRRUP  EXTENSION  STRAP  (BUCK'S  EXTENSION) .' 94 

ANKLE 95 

CHEST 96 

KNEE 98 

LEG 98 

INGUINAL  DRESSING 99 


x  CONTENTS 

ACHILLES  TENDON 99 

THE  TESTICLES 100 

ADHESIVE  SUSPENSORY 100 

PELVIC  BINDER 101 

PART  V 
PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

GENERAL  CONSIDERATIONS 102 

APPLICATION  OF  A  PLASTER  CAST 103 

METHOD  OF  REMOVING  A  PLASTER  CAST 106 

FENESTRATION  OF  CASTS 108 

AMBULATORY  CASTS 109 

SEGMENTED  OR  BRACKET  CASTS no 

PLASTER  SPLINTS no 

BAVARIAN  SPLINT 1 12 

PLASTER  JACKET 113 

PLASTER  SPICA  OF  THE  LOWER  EXTREMITY 1 15 

PLASTER  SHOULDER  CAP 1 18 

SODIUM  SILICATE  (LIQUID  GLASS) 119 

STARCH  BANDAGE 1 19 


ILLUSTRATIONS 


1.  Roller  Bandage,  a,  Single;  b,  Double i 

2.  Bandage  Roller 2 

3.  Rolling  Bandage  by  Hand 3 

4.  Method  of  Holding  a  Bandage 4 

5.  Circular  Turns  of  a  Bandage 5 

6.  Oblique  Fixation  of  a  Bandage 5 

7.  a,  Slow  Spiral  Turns;  b,  Rapid  Spiral  Turns 7 

8.  9.     Spiral  Reverse 8 

10.  Figure-of-8  Turns  (Ascending  Spica) 9 

11.  Figure-of-8  Turns  (Descending  Spica) 9 

12.  Recurrent  Turns 10 

13.  14,  15.     Spiral  Reverse  of  Finger 1 1 

16.  Demigauntlet  Bandage 12 

17.  Gauntlet  with  Spiral  of  Ring  Finger 12 

18.  Spica  of  the  Thumb  (Ascending) 13 

19.  Spica  of  the  Thumb  (Descending) 13 

20.  21.     Spiral  Reverse  of  the  Upper  Extremity 14 

22.  Spiral  Reverse  of  the  Upper  Extremity 15 

23.  Spica  of  the  Shoulder 17 

24.  Spica  Loops  of  the  Shoulder 17 

25.  Spiral  Reverse  of  Lower  Extremity 18 

26.  a,  Spiral  of  Foot  Covering  the  Heel;  b,  Second  Stage 20 

27.  Spiral  of  Foot  Covering  the  Heel 20 

28.  Spica  of  the  Foot  (First  Step) 21 

29.  Spica  of  the  Foot 21 

30.  Figure-of-8  of  the  Leg  (Method  i) 22 

31.  Figure-of-8  of  the  Leg  (Method  2) 23 

32.  Figure-of-8  of  the  Leg  (Method  3) 24 

33.  Figure-of-8  of  the  Leg 26 

34.  Spica  of  the  Groin  (First  Turn) 27 

35.  Spica  of  the  Groin 27 

36.  Spica  of  the  Groin 28 

37.  Spica  of  the  Groin  (Ascending)  with  Oblique  Fixation 29 

38.  Spica  of  the  Groin  (Descending)  with  Oblique  Fixation 29 

39.  Double  Spica  of  the  Groin  (First  Turn) 30 

40.  Double  Spica 30 

41.  Crossed  Bandage  of  Perineum  (First  Turn) 31 

42.  Crossed  Bandage  of  Perineum 31 

xi 


ji  ILLUSTRATIONS 

43.  Crossed  Bandage  of  the  Perineum 32 

44.  Posterior  Figure-of-8  of  the  Shoulders  and  Back 33 

45.  Suspensory  of  the  Breast  (Right) 34 

46.  Suspensory  of  the  Breast .. .  35 

47.  Suspensory  of  the  Breast 36 

48.  Suspensory  of  Both  Breasts 37 

49.  Figure-of-8  of  the  Breast 38 

50.  Figure-of-8  of  the  Breast 39 

5 1 .  Desault  Bandage 40 

52.  Davis  Bandage 41 

53.  Velpeau  (Start) 42 

54.  Velpeau 43 

55.  Velpeau  (Side  View) 44 

56.  Velpeau  (Posterior  View) 45 

57.  Velpeau  (Modified) 45 

58.  Velpeau  Modified  (Dulles) 46 

59.  Figure-of-8  of  the  Head  and  Neck 47 

60.  Barton  Bandage 47 

61 .  Gibson  Bandage 48 

62.  Oblique  of  the  Jaw  (Reverse  Side) 49 

63.  Oblique  of  the  Jaw  (Right  Side) 49 

64.  Double  Oblique  of  the  Jaw 50 

65.  Recurrent  of  the  Scalp  (First  Step) 51 

66.  Recurrent  of  the  Scalp 51 

67.  Transverse  Recurrent  of  the  Scalp  (First  Steps) 52 

68.  Recurrent  of  the  Scalp  with  Double  Roller 53 

69.  •   Crossed  Bandage  of  the  Eye 54 

70.  Crossed  Bandage  of  Both  Eyes 54 

MISCELLANEOUS 

71.  a,  "  T  "  Bandage;  b,  Four-tailed  Bandage 55 

72.  "  T  "  Bandage  of  the  Perineum 56 

73.  Modified  "  T  "  Bandage  of  the  Perineum 56 

74.  Modified  "  T  "  Bandage  of  the  Perineum 57 

75.  "  T  "  Bandage  of  the  Scalp 58 

76.  "  T  "  Bandage  of  the  Eye 58 

77.  "  T  "  Bandage  of  the  Ear 58 

78.  "  T  "  Bandage  of  the  Groin 59 

79.  "  T  "  Bandage  of  the  Buttock 59 

80.  Double  "  T  "  of  Chest 59 

81.  Four-tailed  Bandage  of  the  Chin 60 

82.  Four- tailed  Bandage  of  the  Nose  and  Lip 60 

83.  Quadrangle  Bandage  of  the  Occiput 61 

84.  Quadrangle  Bandage  of  the  Vertex 61 

85.  Quadrangle  Bandage  of  the  Neck 62 


ILLUSTRATIONS 

86.  Quadrangle  Bandage  of  the  Shoulder 62 

87.  Quadrangle  Bandage  of  the  Arm  and  Forearm 62 

88.  Many  Tailed  Bandages 63 

89.  Swathe 64 


HANDKERCHIEF  BANDAGES 

90.  a,  Handkerchief;  b,  Cravat 1 65 

91.  Occipitofrontal  Triangle 66 

92.  Fronto-occipital  Triangle 66 

93.  Bitemporal  Triangle 67 

94.  Verticomental  Triangle 67 

95.  Auriculo-occipital  Triangle 68 

960.  Hunter's  Cap 68 

966.  Hunter's  Cap 68 

970.  Square  Bandage  of  the  Head  (Method  i) 69 

97&.  Square  Bandage  of  the  Head  (Method  2) 69 

97c.  Square  Bandage  of  the  Head  (Method  3) 69 

98.     Posterior  Triangle  of  the  Shoulders 70 

.99.     Thoracicoscapular  Triangle 7° 

100.  Thoracicohumeral  Triangle • 71 

101.  Triangle  Suspensory  of  the  Breast 71 

102.  Triangle  Suspensory  of  Both  Breasts 72 

103.  Brachiocervical  Triangle  or  Sling 72 

104.  Brachiocervical  Triangle  Sling 72 

105.  Brachioscapular  Triangle  Sling -  72 

106.  Brachioscapular  Triangle  Sling 73 

107.  Brachioscapular  Triangle  Sling 73 

108.  Brachioscapular  Triangle  Sling 74 

109.  Mayor's  Bandage 74 

1 10.  Modification  of  Mayor's  Bandage 75 

in.     Shoulder  Triangle 75 

1 12.  Hand  Triangle 76 

1 13.  Anterior  Pelvic  Triangle 76 

114.  Scrotal  Hammock 77 

115.  Scrotal  Hammock 77 

116.  a,  Knee  Triangle;  b,  Foot  Triangle 78 

1 170.  Rubber  Bandage 80 

1 176.  Elastic  Fabric  Bandage 80 

H7c.  Esmarch  Tourniquet 80 

118.  Heating  Adhesive  Plaster 84 

1 19.  Removing  Adhesive  Strips 86 

I2oa.  Rose  Binder  Pattern 87 

I20&.  Rose  Binder  Being  Applied 87 

I2oc.  Rose  Binder  (Posterior  View) 88 


ILLUSTRATIONS 

I2od.  Rose  Binder  (Anterior  View) 88 

121.  Sayre  Dressing  Modified 89 

122.  Acromioclavicular  Support 90 

123.  Adhesive  Dressings 91 

124.  Back  Strapping 93 

125.  Buck's  Extension 94 

126.  Ankle  Strapping 95 

127.  Chest  Strapping 97 

128.  Knee  Strapping 98 

129.  Inguinal  Dressing 99 

130.  Achilles  Tendon  Strapping 100 

131.  Pelvic  Binder 101 

PLASTER 

132.  Making  Plaster  Bandages 102 

133.  Method  of  Squeezing  Water  from  Bandage 104 

134.  Instruments  for  Removal  of  Plaster  Casts 107 

135.  Removal  of  Cast 108 

136.  Fenestration  of  Cast 109 

137-    Segmented  or  Bracketed  Cast no 

138.  Making  Plaster-of- Paris  Splint in 

139.  Making  a  Plaster  Splint  of  Flannel 112 

140.  Plaster  Splint 113 

141.  Moulding  and  Binding  in  Position 113 

142.  Plaster  Splints  Removed 114 

143.  Patient  Suspended  for  Application  of  Plaster-of- Paris  Jacket. ...  114 

144.  Plaster  Jacket 114 

145.  Showing  the  Application  of  a  Plaster  Spica  of  the  Groin.  Using 

the  Martin-Eliason  Sling 1 16 

146.  Cast  Completed  and  the  Patient  is  Being  Placed  in  Bed 117 

147.  Plaster  Shoulder  Cap 1 18 


PRACTICAL  B ANJD AQING 


INCLUDING 


ADHESIVE  AND  PLASTER-OF-PARIS 
DRESSINGS 


PART  I 

ROLLER  BANDAGES 

Fundamental  Facts. — A  roller  bandage  is  a  strip  of 
material  of  any  width  or  length  rolled  upon  itself  to  form 
a  compact  body.  It  may  be  rolled  from  one  end,  single  roller 
(Fig.  i,  a),  or  both  ends,  double  roller  (Fig.  i,  b).  When 
the  word  bandage  is  spoken  of  unqualified,  a  single  roller  is 


FIG.  i. — Roller  bandage,     a,  single;  6,  double. 

meant.  The  roller  has  an  upper  and  lower  edge,  an  inner  and 
outer  surface,  a  body,  an  initial  or  free  end,  and  a  terminal 
or  hidden  end. 

The  purposes  of  a  bandage  are  to  retain  dressing,  to  render 
support,  and  to  make  compression. 

The  material  composing  the  bandage  depends  on  the  pur- 
pose of  the  bandage.  Bandages  for  retaining  dressings  are  of 


2  PRACTICAL  BANDAGING 

gauze  or  muslin.  Gauze  is  oftenest  used  as  it  is  soft  and 
pliable  and  lends  itself  easily  to  the  shape  of  the  part  covered. 
Flannel  and  sheet  wadding  are  used  for  protective  dressings, 
as,  for  .cxailip'IeV  beneath  plaster  of  Paris.  Crinoline  or  tar- 
latan is  used  in  the  production  of  the  comnion  plaster-of-Paris 
bandages  for  fixation  dressing  or  "  cast "  of  a  permanent 
nature,  as  for  fractures  and  dislocations.  Elastic  bandages 


FIG.  2. — Bandage  roller. 

are  employed  for  compression  either  as  a  tourniquet  or  for 
general  uniform  pressure,  as  in  treatment  of  leg  ulcers,  vari- 
cose veins  of  leg,  joint  affections,  shock  and  hemorrhage. 

Preparation  of  Bandages. — Commercial  bandages  of  any 
description  may  be  obtained  from  almost  any  drug  store  or 
surgical  supply  house.  They  may  be  bought,  if  so  desired, 
put  up  in  sterile  packages.  Should  it  be  desired  to  make  one's 
own  bandages  a  length  of  the  desired  material  is  procured 


ROLLER  BANDAGES 

o 

and  the  selvage  removed.  The  width  is  now  divided  at  the 
extremity  into  the  desired  bandage  width  and  each  strip  torn 
down  about  a  foot.  The  alternate  strips  are  then  pulled 
separate  ways  tearing  the  entire  length  of  the  piece  of  ma- 
terial. Cutting  the  strips  gives  a  neater  bandage.  The 
material,  folded  into  several  layers,  the  top  layer  marked 
off  into  bandage  widths  with  a  pencil,  is  cut  along  the  lines, 
with  heavy  scissors. 


FIG.  3. — Rolling  bandage  by  hand. 

How  to  Roll  Bandages — Bandages  are  rolled  on  a  ma- 
chine, the  bandage  roller,  or  by  hand. 

By  Machine. — By  the  use  of  the  bandage  roller  (Fig.  2) 
the  bandage  can  be  rolled  in  a  very  short  time.  It  is  a  small 
winch,  which  is  fastened  to  the  table.  The  bandage  is  fed 
through  the  guide  bars,  moistened  on  its  end  and  wound 
around  the  smaller  end  of  the  winch  rod.  It  is  then  slid  over 
to  the  increasing  diameter  of  the  rod  until  it  sticks  fast. 
When  the  entire  bandage  is  rolled,  the  roll  is  grasped  tightly 
with  the  left  hand  and  the  winch  turned  two  or  three  times, 


4  PRACTICAL  BANDAGING 

thus  tightening  the  roll.  Back  the  winch  rod  three  or  four 
turns  and  withdraw  from  the  roll. 

By  Hand  (Fig.  3). — Eighteen  inches  at  one  end  of  the 
bandage  is  folded  repeatedly  on  itself  until  the  reduplicated 
portion  is  three  or  four  inches  long.  This  is  now  tightly 
rolled  by  a  finger  and  thumb  until  the  roll  is  large  enough  and 
firm  enough  to  withstand  a  fair  amount  of  pressure  in  the 
direction  of  its  long  axis,  without  bending,  between  thumb 
and  forefinger.  Grasp  the  roll  between  the  thumb  and  index 
finger  of  the  left  hand,  the  body  of  the  roll  being  beneath  and 
the  free  end  passing  over  the  index  finger,  between  it  and  the 


FIG.  4. — Method  of  holding  a  bandage. 

thumb,  of  the  right  hand.  Holding  the  roll  firmly  with  the 
left  hand,  allowing  free  portion  of  bandage  to  slip  through  the 
right  hand,  supinate  both  hands,  then,  grasping  roll  between 
the  thumb  eminence  and  fourth  and  fifth  fingers  of  the  right 
hand,  release  pressure  of  the  left  finger  and  thumb  pronating 
both  hands.  Repetition  of  these  movements  rolls  the  bandage. 
Rolling  a  bandage  may  also  be  accomplished  on  one's  thigh 
or  on  a  flat  surface,  placing  the  rolled  portion  of  the  bandage 
on  the  flat  surface  between  it  and  the  flexor  surface  of  the 
tips  of  the  fingers.  By  gentle  pressure  the  fingers  are  pushed 
forward  in  the  direction  of  the  free  end  of  the  strip  lying 
extended  beyond,  thus  rolling  the  bandage  on  itself.  The 
bandage  when  rolled  should  be  tight,  with  even  edges,  and 
free  from  ravellings. 


ROLLER  BANDAGES  5 

Starting  Bandages.— Grasp  roller  with  body  uppermost 
( Fig.  4  ) ,  in  right  hand,  with  three  or  four  inches  of  free  end. 
Apply  this  initial  extremity  smoothly  on  the  part  and,  holding 
the  end  firmly  against  the  part,  allow  roller  to  run  to  the 
right  around  the  part  to  the  back  when  it  is  transferred  to  the 
left  hand,  the  right  hand  now  fixing  the  initial  extremity. 
The  left  hand  brings  the  roller  front  where  it  again  is  taken 
by  right  hand  and  the  second  turn  begun,  exactly  overlaying 
the  first  in  order  to  "  fix  "  the  initial  extremity.  These  turns 


FIG.  5.— Circular  turns  of  a  bandage.  FIG.  6.— Oblique  fixation  of  a  bandage. 

are  called  simple  or  circular  turns  and  should  be  placed  at 
the  point  of  the  least  diameter  of  the  part  bandaged  (Fig.  5), 
(i.e.,  at  ankle  or  wrist,  rather  than  at  mid-calf  or  mid-fore- 
arm). The  initial  extremity  may  be  fixed  by  the  oblique 
method  also,  as  shown  in  (Fig.  6). 

Requisites  of  a  Bandage. — The  desired  result  should  be  ac- 
complished with  the  least  turns  possible.  All  similar  turns 
should,  as  far  as  possible,  have  the  same  distance  between 
them,  and  their  edges  as  near  parallel  as  possible.  Each  turn 
must  be  evenly  and  firmly  applied,  showing  no  wrinkles  or 


6  PRACTICAL  BANDAGING 

ravellings  or  gaps  between  turns.  The  surface  of  the  band- 
age must  lie  flat  on  the  part  bandaged.  If  applied  too  loosely 
the  bandage  displaces  easily.  If  applied  too  tightly  it  is  un- 
comfortable and  may  obstruct  the  blood  supply  causing  swell- 
ings, discoloration,  numbness  and  tingling,  pallor,  coldness 
or  subsequent  gangrene  if  tight  enough  to  shut  off  blood 
supply.  In  applying  turns  near  a  joint  care  should  be  taken 
to  have  the  joint  in  the  position  in  which  it  is  to  remain  after 
the  dressing  is  completed.  Special  care  must  be  taken  with 
regard  to  bony  prominences  that  they  are  well  protected  from 
pressure  by  the  interposition  of  cotton.  Skin  surfaces  ought 
never  to  be  bandaged  in  direct  contact.  Always  interpose 
gauze  or  lint  whenever  possible.  Leave  some  portion  of  the 
part  distal  to  the  bandage  exposed  whenever  possible,  in  order 
that  the  circulation  may  be  watched.  In  applying  a  simple 
circular  bandage  around  a  cylindrical  part,  place  the  initial 
extremity  at  right  angles  to  the  axis  of  the  part.  In  case  one 
bandage  is  too  short  for  the  dressing,  confine  the  distal  ex- 
tremity by  one  or  two  fixation  turns  of  a  second  bandage, 
and  then  proceed  as  before. 

Ending  a  Bandage. — After  the  application  is  completed, 
the  distal  extremity  may  be  secured  by  a  pin,  adhesive  strips, 
sewing,  or  splitting  the  end  of  the  bandage  for  a  distance 
of  more  than  half  the  diameter  of  the  part  and  passing  the 
ends  around  in  opposite  directions  and  tying.  Should  none 
of  these  methods  be  feasible,  simply  tuck  the  end  of  the  band- 
age under  the  last  turn  applied. 

Fundamental  Turns  or  Bandages — A  circular  bandage  is 
applicable  to  cylindrical  parts,  the  turns  being  applied  at 
right-angles  to  the  long  axis  of  part  and  each  turn  exactly 
overlapping  the  preceding  ( Fig.  5 ) . 

A  spiral  bandage  covers  a  part  in  a  spiral  manner.  Begin- 
ning with  a  circular  turn  to  fix  the  bandage,  it  is  then  carried 
slightly  upward  and  spirally  around  the  part,  each  turn 


ROLLER  BANDAGES 


paralleling  the  preceding  one 
which  it  overlaps  from  one-half 
to  two-thirds  its  width.  The 
spiral  bandage  may  be  ascend- 
ing or  descending  depending 
upon  whether  the  succeeding 
turns  approach  or  recede  from 
the  trunk.  The  ascending 
spiral  is  the  one  generally  em- 
ployed. A  slow  spiral  covers 
a  conical  part  slowly,  leaving  * 
no  gaps  (Fig.  7,  a).  A  rapid 
spiral  proceeds  up  the  part 
rapidly,  leaving  gaps  between 
turns  (Fig.  7,  b). 

A  spiral  reverse  bandage  is 
used  under  those  conditions 
where  the  shape  of  the  part  to 
be  covered  is  that  of  a  rapidly 
increasing  cone.  Here,  in  order 
to  have  the  bandage  lie  flat, 
and  yet  permit  no  gaps,  the 
direction  of  spiral  turns  must 
be  changed.  The  reverse  ac- 
complishes this  and  is  made 
as  follows :  When  in  the  appli- 
cation of  spiral  turns,  a  point 
is  reached  where  by  reason  of 
the  increased  conical  shape  of 
the  part,  the  bandage,  in  order 
to  lie  flat  and  not  lose  its 
parallelism  to  the  last  turn,  or 
to  prevent  gaping,  must  be 
reversed,  then  the  body  of 


PIG.  7. — a,  slow  spiral  turns;  6,  rapid 
spiral  turns. 


8 


PRACTICAL  BANDAGING 


the  bandage  is  unrolled  five  or  six  inches,  the  thumb  of 
the  left  hand  is  placed  on  the  upper  edge  of  the  last  turn,  and 
held  firmly  to  prevent  loosening  (Fig.  8).  Relax  the  pull 
with  the  right  hand,  approximating  the  part  and  at  the  same 
time  pronate  the  hand,  thus  turning  over  or  reversing  the 
body  of  the  bandage.  Carry  the  bandage  directly  down 


FIGS.  8  and  9. — Spiral  reverse. 

the  long  axis  of  the  limb  and  then  obliquely  to  the 
right  until  the  turned  upper  edge  meets  the  left  thumb 
(dotted  line  in  Fig.  8).  Pass  the  roller  around  the 
limb  (Fig.  9)  the  lower  edge  overlapping  one-half  the 
previous  roll.  It  is  then  grasped  by  the  fingers  of  the  left 
hand,  the  left  thumb  still  remaining  at  the  reverse.  Now 


ROLLER  BANDAGES  9 

give  gentle  traction  to  settle  the  reverse  in  place.  Reverses 
are  always  made  toward  the  operator  or  toward  the  smaller 
end  of  the  cone  and  should  not  be  employed  unless  needed. 

Figure-of-8  turns  are  the  ones  most  used  in  bandaging. 
The  bandage  consists  of  two  loops  made  in  the  form  of  an 
eight  (8)  and  are  usually  employed  in  covering  a  joint  or  in 
place  of  a  spiral  reverse.  When  a  number  of  figure-of-8 
turns  are  applied,  each  a  little  higher  or  lower,  overlapping  a 
portion  of  each  preceding  turn,  so  as  to  give  an  imbricated 


FIG.  10. — Figure-of-8  turns.     (Ascending 
spica.) 


FIG.  ii. — Figure-of-8  turns.  (Descending 
spica.) 


appearance  it  is  called  a  spica  (Fig.  10).  The  spica -is  ascend- 
ing (Fig.  10)  or  descending  (Fig.  n)  depending  upon 
whether  the  turns  proceed  up  or  down  the  part. 

Recurrent  turns  are  used  to  cover  the  scalp  (Fig.  12), 
stumps,  and  extremities.  First,  fix  the  initial  extremity  by 
circular  turns,  then  reverse  and  pass  backward  and  forward 
over  the  part  to  be  covered,  applying  the  first  turn  over  the 
centre  and  each  succeeding  turn  alternating  on  each  side. 
Complete  the  bandage  by  reversing  after  the  last  recurrent 
turn  and  applying  two  or  three  circular  turns  over  the  first 
or  fixation  turns. 


IO 


PRACTICAL  BANDAGING 


For  years  the  classical  bandages  have  been  taught  the 
same  way  with  but  few  modifications.  Many  useless  turns 
have  been  retained  to  the  present  day,  although  daily  proven 
unpractical  and  useless  clinically.  The  classical  bandage  will 
be  given  below,  also  those  modifications  that  seem  of  more 
practical  use  than  the  original. 

Spiral  of  Finger  (Fig.  17,  Ring  Finger)  (Bandage  3 
Yards  x  i  Inch). — Fix  bandage  by  circular  or  oblique  turns 

around  the  wrist.  Carry 
diagonally  across  dorsum  of 
hand  to  base  of  finger.  En- 
circle the  finger  by  a  rapid 
spiral  in  the  same  direction 
until  the  root  of  the  nail  is 
reached.  Cover  in  the  finger 
with  spiral  turns  progressing 
to  the  base  of  the  finger  by 
overlapping  each  previous 
turn  one-half  the  bandage 
width.  On  completion  of 
the  finger  carry  the  bandage 
across  the  dorsum  of  hand 
and  down  around  the  wrist. 
All  the  turns,  both  wrist  and 
finger  should  be  in  the  same 
general  direction. 

Spiral  Reverse  of  the  Finger  (Figs.  13,  14  and  15) 
(Bandage  3  Yards  x  i  Inch) . — Fix  the  bandage  by  two  circu- 
lar turns,  or  an  oblique  .turn  around  the  wrist,  then  carry  it 
diagonally  over  the  dorsum  of  the  hand  to  the  base  of  the 
finger.  Descend  the  finger  by  a  rapid  spiral  covering  the  tip 
by  two  or  three  recurrent  turns,  holding  the  turns  with  the 
forefinger  and  thumb  of  the  left  hand.  Now  reverse  the  last 
dorsal  turn  and  carry  the  bandage  around  the  finger,  with 


FIG.  12. — Recurrent  turns. 


ROLLER  BANDAGES 


II 


12 


PRACTICAL  BANDAGING 


spiral  reverse  turns,  in  the  same  direction  of  the  first  turns 
around  the  wrist.  Continue  these  turns,  overlapping  one-half 
to  one-third,  until  the  upper  edge  of  the  bandage  reaches 
the  finger  web.  Then  direct  the  two  circular  turns  around 
the  wrist. 

Demigauntlet  Bandages  (Fig.  16)  (Bandage  3  Yards  x  i 
Inch). — Fix  the  bandage  around  the  wrist.     Carry  the  band- 


FIG.  1 6. — Demigauntlet  bandage. 


FIG.  17. — Gauntlet  with  spiral  of  ring  finger. 


age  across  the  back  of  the  hand  and  loop  around  the  base 
of  the  thumb  or  little  finger,  then  back  to  wrist  and  around 
it  in  same  direction.  By  applying  repeated  similar  turns 
around  each  successive  digit,  the  entire  dorsum  of  the  hand  is 
covered. 

Gauntlet   Bandage    (Fig.    17)    (Bandage   3   Yards   x    I 
Inch). — This  bandage  is  simply  composed  of  spiral  reverse 


ROLLER  BANDAGES  I3 

bandages  of  all  the  digits.  Each  digit,  beginning  with  either 
the  first  or  fifth,  is  covered  in  order  with  the  spiral  or  spiral 
reverse  turns,  care  being  taken  that  all  the  turns  on  each 


FIG.  19. — Spica  of  the  thumb  (descending).      FIG.  18. — Spica  of  the  thumb  (ascending). 

finger  have  the  same  direction  around  the  wrist  and  fingers. 
No  turns  should  cross  the  palm. 

NOTE. — The  reader  will  notice  that  in  none  of  the  illustrations  is 
the  fixation  turn  designated  by  a  number.  The  No.  I  is  always  found 
on  the  first  turn  characterizing  the  bandage  depicted. 


PRACTICAL  BANDAGING 


ROLLER  BANDAGES 


to 


Spica  of  the  Thumb  (Fig.  18) 
(Bandage  3  Yards  x  i  Inch). — Fix 
the  initial  extremity  by  one  or  two 
turns  around  the  wrist,  then  carry  the 
bandage  downward  across  the  base 
of  thumb  and  down  the  thumb  by  a 
rapid  spiral  to  the  root  of  the  nail. 
Here  apply  one  or  two  spiral  turns 
until  the  upper  edge  of  the  bandage 
touches  the  web  of  the  thumb.  Fig- 
ure-of-8  turns  are  then  made  around 
the  thumb  and  wrist  overlapping  one- 
third  to  one-half  the  turn  preceding, 
thus  making  the  spica.  An  ascending 
(Fig.  18)  or  descending  spica  (Fig. 
19)  may  be  applied.  Finish  by  one  or 
two  turns  around  the  wrist. 

Spiral  Reverse  of  Upper  Extremity 
(Figs.  20,  21  and  22)  (Bandage  5 
Yards  x  2^/2  Inches). — Fix  initial  ex- 
tremity on  the  wrist  and  then  carry 
the  bandage  obliquely  down  over  the 
dorsum  of  the  hand  to  the  web  of 
the  thumb,  around  the  outer  side  of 
the  index  finger,  across  the  palm  and 

FIG.  22.— Spiral  reverse  of  the  around    the    little    finger,    with    the 
lower  edge  of  the  turn  crossing  the 


upper  extremity. 


!6  PRACTICAL  BANDAGING 

second  joint  of  the  ring  finger.  Make  a  circular  turn  at  this 
point  and  as  the  bandage  crosses  the  little  finger  the  second 
time,  it  should  cover  one-half  the  preceding  turn.  Then  carry 
obliquely  upward  across  to  and  around  the  first  joint  of  the 
thumb.  Crossing  the  palmar  surface  again  to  ulna  side 
another  turn  is  taken  around  the  hand  below  the  thumb, 
overlapping  one-half  the  previous  turn.  Now  make  one  or 
two  figure-of-8  turns  around  the  hand  above  and  below  the 
thumb,  until  the  hand  is  covered.  Next  carry  the  bandage 
to  the  wrist  and  cover  the  forearm  with  spiral  or  spiral  re- 
verses as  required  until  within  four  inches  of  the  elbow.  Flex 
the  elbow  and  carry  the  bandage  with,  its  centre  over  the 
point  of  the  elbow,  and  return  to  front  of  forearm  covering 
one-half  or  one-third  the  last  turn.  The  bandage  is  carried 
from  here  across  the  front  of  the  elbow  and  up  around  the 
lower  part  of  arm  overlapping  one-half  of  the  turn  covering 
the  elbow  tip.  The  next  turn  passes  around  the  upper  fore- 
arm covering  in  the  lower  edge  of  the  elbow  turn.  Proceed 
from  here  on  up  the  arm  with  spiral  reverse  turns  as  required. 
Finish  with  one  or  two  circular  turns. 

Spica  of  the  Shoulder  (Fig.  23)  (Bandage  8  Yards  x  2^ 
Inches). — Fix  the  initial  extremity  by  a  circular  turn  around 
the  upper  arm,  having  the  upper  edge  reaching  the  axillary 
folds.  It  is  next  carried  obliquely  upward  and  across  the 
prominence  of  the  shoulder  around  the  chest  under  the  oppo- 
site axilla  and  returned  crossing  the  previous  turn  over  the 
shoulder  at  a  point  midway  between  chest  and  back.  Now 
make  a  loop  around  the  arm  then  around  the  body.  Repeat 
this  last  figure-of-8  turn  until  the  shoulder  is  covered,  the 
turns  rising  higher  in  ascending  and  getting  lower  in  descend- 
ing spica  (Fig.  24),  each  overlapping  the  last  turn  one-half 
to  two-thirds  over  the  shoulder,  but  exactly  covering  the 
preceding  turns  under  the  opposite  axilla.  In  applying  this 
bandage  the  operator  stands  beside  and  facing  the  shoulder 


ROLLER  BANDAGES  I7 

that  is  being  bandaged.  To  bandage  the  left  shoulder  fix 
the  initial  extremity  from  before  backward  high  up  on  the 
arm  by  one  or  two  circular  turns  then  passing  backwards 
and  upwards  over  the  shoulder  tip  and  around  the  back.  It  is 
much  more  secure  to  fix  your  spica  bandage  of  the  shoulder 
by  a  spica  loop  beginning  well  away  from  the  shoulder  and 
looping  the  arm  as  do  the  subsequent  turns  (Fig.  24).  Here 
the  initial  extremity  lies  hidden  under  turn  (i)  posteriorly. 


PIG.  23. — Spica  of  the  shoulder. 


FIG.  24. — Spica  loops  of  the  shoulder. 


Spiral  Reverse  of  the  Lower  Extremity  (Fig.  25)  (Band- 
age 8  Yards  x  2^/2  to  3  Inches). — Fix  the  initial  extremity 
obliquely  across  the  ankle-joint,  then  carry  the  bandage  diag- 
onally down  across  the  dorsum  of  the  foot  to  ball  of  great 
toe  (if  on  right  foot),  under  the  foot  and  around  the  base 
of  the  small  toe.  A  circular  turn  here  and  then  one  or  two 
spirals  are  made  until  the  instep  is  reached,  when  reverses 
are  used  up  to  the  point  of  the  instep.  The  next  turn  in- 
stead of  reversing  passes  up  around  the  ankle  low  down, 
then  down  around  the  foot  and  up  the  outside  of  the  foot 
around  the  ankle  (figure-of-8  turns)  covering  one-half  the 


i8 


PRACTICAL  BANDAGING 


FIG.  25. — Spiral  reverse  of  lower  extremity. 


ROLLER  BANDAGES  !9 

previous  turn,  the  foot  turns  approaching  the  heel,  the  ankle 
turns  receding  from  the  heel.  The  bandage  is  now  carried  up 
the  leg  with  spiral  and,  as  needed,  spiral  reverse  turns  until 
the  upper  edge  of  the  last  turn  reaches  the  lower  border  of 
the  patella  (with  leg  extended).  Pass  the  next  turn  directly 
over  the  patella  (knee-cap)  and  a  succeeding  turn  over  the 
lower  half  of  the  patella  after  which  the  upper  half  is  covered 
with  a  turn  and  the  bandage  then  carried  up  the  thigh  with 
spiral  reverse  turns.  When  desiring  to  bandage  the  left 
foot,  the  first  turn  after  fixation  of  the  bandage  is  obliquely 
down  across  the  instep  to  the  base  of  the  little  toe,  under 
foot,  and  around  the  great  toe  base,  then  proceed  as  above. 
This  bandage  is  very  difficult  to  retain  in  place  if  the  leg  is 
dependent  or  in  use.  It  is  best  used  therefore  in  reclining 
cases.  For  ambulatory  cases  the  figure-of-8  bandage  is  pre- 
ferable. 

Spiral  of  the  Foot  Covering  the  Heel  (Figs.  26  and  27) 
(Bandage  3  Yards  x  2  Inches). — To  bandage  the  right  foot, 
fix  the  initial  extremity  around  the  ankle  obliquely ;  then  pass 
down  diagonally  across  instep  to  ball  of  great  toe,  around  the 
sole  and  around  the  base  of  little  toe  and  up  on  the  dorsum. 
A  circular  turn  here  is  followed  by  spiral  or  spiral  reverse 
turns  until  the  apex  of  instep  is  reached.  The  bandage  is  then 
carried  with  its  centre  over  the  point  of  the  heel,  up  the 
outside  of  the  foot  to  instep,  then  down  the  inner  side  of  foot 
obliquely,  under  the  sole,  transversely  across  the  outer  side 
of  the  heel,  behind  the  tendo  Achilles,  back  to  the  instep, 
down  the  outer  side  of  foot,  obliquely  under  the  sole,  trans- 
versely across  the  inner  side  of  the  heel,  behind  the  tendo 
Achilles  and  back  to  the  instep.  End  bandage  by  circular 
turns  around  the  ankle.  For  left  foot,  fix  bandage  as  for 
right  foot,  the  bandage  being  applied  toward  the  operator's 
right  hand,  then  carry  obliquely  down  across  instep  to  base 
of  little  toe,  proceeding  from  here  as  for  right  foot. 


2O 


PRACTICAL  BANDAGING 


FIG.  27 


FIG.  26. — a,  Spiral  of  foot  covering  the  heel ;  b,  second  stage. 
FIG.  27. — Spiral  of  foot  covering  the  heel. 


ROLLER  BANDAGES  2I 

Spica  of  the  Foot  (Figs.  28  and  29)  (Bandage  3  Yards  x 
2  Inches). — Fix  the  bandage  around  the  ankle,  then,  for  right 
foot,  carry  the  turn  obliquely  across  the  dorsum  of  the  foot 
to  the  ball  of  the  great  toe.  A  circular  turn  is  made  around 
the  base  of  the  foot  across  and  up  the  instep,  around  the 
heel.  The  upper  edge  of  the  bandage  should  just  grasp  the 
heel,  the  lower  edge  being  left  loose.  Now  return  to  the 


FIG.  28. — Spica  of  the  foot  (first  step).  FIG.  29. — Spica  of  the  foot. 

lower  instep  crossing  the  last  turn  in  the  middle  of  the  foot 
and  covering  two- thirds  of  the  width  of  the  bandage.  Repeat 
similar  alternate  turns  around  the  foot  and  the  heel  taking 
care  that  those  on  the  foot  approach  the  heel  and  that  those 
on  the  back  of  the  heel  ascend  the  ankle.  The  upper  edge  of 
the  last  turn  around  the  foot  should  cover  the  lower  edge  of 
the  first  turn  around  the  heel.  The  bandage  is  ended  by  one 
or  two  circular  turns  around  the  ankle.  It  will  be  noted  that 


22 


PRACTICAL  BANDAGING 


the  last  one  or  two  turns  crossing  under  the  foot  have  one 
edge  loose.  This  can  be  avoided  by  reversing  the  bandage  on 
the  side  of  the  foot  before  going  up  the  instep.  To  bandage 
the  left  foot,  after  fixing  the  bandage  around  the  ankle  in  the 
above  manner,  direct  the  next  down  across  the  instep  to  the 


FIG.  30. — Figure-of-8  of  the  leg  (method  i). 

base  of  the  little  toe  and  then  make  a  circular  turn  around  the 
ball  of  the  foot.  From  this  point  proceed  as  for  right  foot. 
Figure-of-8  of  the  Leg  (Fig.  33)  (Bandage  5  Yards  x  2 
or  3  Inches. — Method  i  (short  loop  method)  (Fig.  30)  : 
The  bandage  is  similar  to  the  spiral  reverse  of  the  lower  ex- 


ROLLER  BANDAGES 


FIG.  31. — Figure-of-8  of  the  leg  (method  2). 


tremity  until,  on  ascending  the  calf,  reverses  are  needed.  Then 
incline  the  bandage  rapidly  upward  by  rapid  spiral  or  oblique 
turn  to  lie  flat,  make  a  turn  around  the  leg  and  returning 


PRACTICAL  BANDAGING 


ROLLER  BANDAGES  25 

in  downward  direction  to  front  of  leg,  cross  the  first  turn 
just  outside  the  crest  of  the  tibia.  Successive  similar  turns 
of  the  figure-of-S  variety  are  made  overlapping  one-half  of 
each  previous  turn  as  the  bandage  ascends  the  leg.  It  will 
be  noted  that  there  is  a  gap  posterior  between  the  two  loops 
of  the  8  and  that  the  lower  edge  of  the  upper  loop  does  not 
lie  flat.  Both  of  these  defects  are  covered  by  the  ascending 
turns  as  they  ascend  the  leg.  Complete  the  bandage  by  two 
circular  turns  above  the  calf. 

Method  2  (long  loop  method)  (Fig.  31):  This  makes 
use  of  a  large  loop  below  and  a  small  loop  above  when  start- 
ing the  figure-of-8  turns,  both  approaching  the  place  of 
greatest  diameter  where  two  circular  turns  end  the  bandage. 

Method  j  (Fig.  32)  :  Likewise  similar  to  the  spiral  re- 
verse until  the  increased  diameter  of  the  calf  demands  re- 
verses. Then  a  long  loop  of  the  figure  8  carries  the  bandage 
above  the  greatest  diameter  of  the  calf  where  a  circular  turn 
passes  directly  around  the  leg  above  the  calf  and  then  de- 
scends, crossing  the  long  loop  just  outside  the  crest  of  the 
tibia  to  pass  across  the  lower  leg  in  a  short  loop.  There 
turns  are  repeated,  each  large  loop  covering  one-half  the  last 
turn  and  each  circular  turn  passing  above  the  greatest 
diameter  of  the  calf. 

The  figure-of-8  of  the  leg  is  a  very  popular  bandage  and 
reasonably  so,  for  it  retains  its  place  better  than  any  other 
leg  bandage.  The  increased  amount  of  bandage  necessary 
for  its  application  is  its  only  objection.  All  three  methods 
give  the  same  appearance  when  completed  (Fig.  33). 

Spica  of  the  Groin  (Figs.  34  and  35)  (Bandage  8  Yards 
x  3  Inches). — The  initial  extremity  is  fixed  by  two  circular 
turns  high  up  around  the  thigh.  If  the  right  groin  is  to  be 
bandaged,  from  the  outer  surface  of  the  thigh  the  bandage  is 
carried  diagonally  across  the  groin  just  above  the  pubis  and 
around  the  crest  of  the  iliac  (hip)  bone  of  the  left  side, 


26 


PRACTICAL  BANDAGING 


IZ 


FIG.  33. — Figure-of-8  of  the  leg. 

thence  across  the  lower  back,  between  the  right  iliac  (hip) 
crest  and  trochanter.  From  here  the  turn  passes  obliquely 
downward  and  crosses  the  first  ascending  turn,  about  the 
middle  of  the  groin.  Apply  three  or  four  of  these  figure-of-8 
turns,  each  turn  covering  about  one-half  the  previous  turn 


ROLLER  BANDAGES 


FlG.  34. — Spica  of  the  groin  (first  turn). 


PIG.  35- — Spica  of  the  groin. 


2g  PRACTICAL  BANDAGING 

as  it  rounds  the  thigh  and  groin  but  always  passing  around 
and  below,  not  above,  the  iliac  crest  on  its  course  around  the 
pelvis  permitting  the  upper  turns  to  grasp  the  hip  bones  but 
not  to  pass  above  them.  The  bandage  is  usually  ended  by  a 
circular  turn  around  the  pelvis  just  below  the  crests.  There 
is  a  much  more  practical  and  secure  method  of  applying  the 
spica  of  the  groin,  by  starting  the  bandage  with  the  initial 


FIG.  36. — Spica  of  the  groin. 

extremity  passing  over  the  groin  obliquely  and  around  the 
thigh,  thence  across  above  the  symphysis  and  continued  as 
above.  This  is  finished  with  the  spica  turns  and  not  by  cir- 
cular turns  around  the  trunk  or  thigh  (Figs.  37  and  38). 
Should  it  be  desired  to  bandage  the  left  groin  the  circular 
turns  around  the  thigh  pass  from  within  toward  the  outer 
surface.  The  first  ascending  turn  passes  obliquely  in  the 
line  of  the  groin  up  to  and  between  the  opposite  crest  and 


ROLLER  BANDAGES 


29 


the  trochanter.     The  remaining  turns  are  exactly  similar  to 
the  ones  applied  for  the  right  groin. 

Double  Spica  of  the  Groin  (Figs.  39  and  40)  (Bandage 
8  Yards  x  3  Inches). — Fix  the  initial  extremity  by  two  cir- 
cular turns  on  the  right  thigh  as  high  as  possible.  Direct  the 
bandage  from  the  outer  aspect  of  the  thigh,  across  the  groin, 
above  the  symphysis  pubis,  around  the  pelvis  gripping  the 
crest  on  each  side,  diagonally  across  lower  abdomen,  crossing 


FIG.  37. — Spica  of  the  groin  (ascending)  with  oblique  fixation. 
FIG.  38. — Spica  of  the  groin  (descending)  with  oblique  fixation. 

the  previous  turn  just  above  the  symphysis  whence  it  reaches 
the  outer  surface  of  the  left  thigh.  Make  a  circular  turn 
around  the  thigh,  as  high  up  as  possible  and  on  the  second 
arrival  on  the  inner  aspect  of  the  left  thigh  carry  the  bandage 
up  the  line  of  the  groin  around  the  left  iliac  crest  and  then 
make  a  complete  circular  turn  around  the  pelvis.  When  the 
right  side  is  reached  the  second  time,  drop  obliquely  down- 
ward along  the  right  groin  to  the  point  of  starting.  The 
remaining  bandage  is  merely  a  repetition  of  this  one  com- 


PRACTICAL  BANDAGING 


FIG.  39. — Double  spica  of  the  groin  (first  turn). 


FIG.  40. — Double  spica. 


ROLLER  BANDAGES 


plete  turn,  covering  about  one-half  each  previous  turn.  When 
the  bandage  is  completed  there  will  be  noted  three  spicas; 
one  in  each  groin  and  one  over  the  symphysis.  This  bandage, 
as  well,  can  be  applied  with  the  same  modifications  as  are 
made  in  the  single  spica  of  the  groin,  namely,  omission  of  the 
horizontal  turns  around  the  pelvis  and  thigh.  Here  too,  this 
spica  bandage  may  be  either  ascending  or  descending. 

Crossed  Bandage  of  the  Perineum  (Figs.  41,  42  and  43) 
(Bandage  8  Yards  x  3  Inches).  —  Start  the  bandage  crossing 
the  lower  abdomen  and  left  groin  diagonally,  passing  behind 


FIG.  41. — Crossed  bandage  of  perineum  FIG.  42. — Crossed  bandage  of 

(first  turn).  perineum. 

and  well  up  on  the  left  thigh,  crossing  the  perineum  to  right 
groin  (i).  From  here  carry  the  roller  along  the  line  of  the 
right  groin  around  the  iliac  (hip  bone)  crests,  diagonally 
across  the  abdomen  (2)  and  around  the  posterior  aspect  of 
the  thigh  high  up.  From  here  the  bandage  crosses  the  first 
turn  in  the  perineum  proceeding  up  the  line  of  the  left  groin 
(3)  around  the  left  hip,  grasping  the  crest  of  the  hip  bone, 
across  the  back  around  the  right  hip  crest  diagonally  across 
the  abdomen  (4),  to  pass  around  the  outer  and  posterior  as- 
pect of  the  thigh  high  up,  thus  completing  one  entire  turn.  It 
should  be  noticed  that  the  initial  extremity,  E,  is  covered  by 


PRACTICAL  BANDAGING 


turn  4  as  it  crosses  the  abdomen  in  the  same  direction.  Cross- 
ing the  perineum  direct  the  bandage,  overlapping  two-thirds 
the  width  of  the  previous  turns,  along  the  right  groin  (5), 
around  right  crest,  around  the  back  and  left  crest,  diagonally 
across  the  abdomen  (6),  around  the  outside  of  the  right 
thigh,  posteriorly,  to  cross  the  perineum.  Now  pass  up  the 


, 


4 


FIG.  43. — Crossed  bandage  of  the  perineum. 

line  of  the  left  groin  (7),  around  the  left  hip  across  the 
back  around  the  right  hip  down  across  the  abdomen  (8), 
around  the  outside  of  the  left  thigh  posteriorly  and  across  the 
perineum.  Passing  up  the  right  groin  (9),  continue  around 
back  to  left  side  (10),  etc.,  until  a  sufficient  number  of  turns 
are  applied.  The  bandage  should  show  four  series  of  spicas 
as  seen  in  the  illustrations. 


ROLLER  BANDAGES 


33 


The  bandage  may  be  applied,  fixing  the  initial  extremity 
around  the  thigh  and  alternating  the  direction  of  the  spica 
perineal  turns.  This  older  method  has  no  advantage  over 
the  above  and  is  much  more  confusing. 

Posterior  Figure-of-8  of  Shoulders  and  Back  (Fig.  44) 
(Bandage  5  Yards  x  2  Inches). — Standing  behind  the  patient 
apply  the  initial  extremity  of  the  bandage  on  the  posterior 


FIG.  44. — Posterior  figure-of-8  of  the  shoulders  and  back. 

aspect  of  the  sound  axilla.  Carry  the  bandage  obliquely 
across  the  back  to  pass  over  the  opposite  shoulder  well  out  on 
the  point,  down  through  the  axilla  to  its  posterior  border  then 
across  the  back  to  the  other  shoulder  going  around  it  and 
through  the  axilla  to  point  of  starting.  Repeated  turns  five 
or  six  in  number,  proceeding  up  the  back  and  toward  the  base 
of  the  neck,  by  each  turn  overlapping  the  preceding  one,  com- 
pletes the  bandage.  The  finished  bandage  shows  a  spica  mid- 
way the  shoulders. 
3 


-4  PRACTICAL  BANDAGING 

Anterior  Figure-of-8  of  Shoulders  and  Chest — This  band- 
age is  similar  to  the  above,  differing  only  in  that  it  is  applied 
anteriorly  over  the  chest  rather  than  posteriorly  over  the 
back. 

Suspensory  of  the  Breast  (Fig.  45)  (Bandages  8  Yards 
x  3  Inches). — To  bandage  the  right  breast  fix  the  bandage 


FlG.  45. — Suspensory  of  the  breast  (right). 

by  two  circular  turns  around  the  chest  just  below  the  breast, 
passing  from  patient's  right  to  left.  On  arriving  beneath  the 
right  breast  the  second  time  direct  the  next  turn  upwards  be- 
tween the  breasts  and  across  the  left  shoulder,  then  down 
across  the  back  to  point  of  starting  beneath  the  right  breast. 
Repeating  these  turns  alternately  for  four  or  five  times  com- 


ROLLER  BANDAGES  3- 

pletes  the  bandage.  The  horizontal  turns  ascending  by  over- 
lapping one-half  and  the  oblique  turns  proceed  outward  over 
the  breast  overlapping  about  one-half  the  width  of  each 
previous  turn.  The  points  of  crossing  should  be  just  under 
the  breast.  The  turns  as  they  pass  over  the  shoulder  tend  to 
overlap  each  other  much  more  than  when  crossing  the  breast 


FIG.  46. — Suspensory  of  the  breast. 

To  bandage  the  left  breast  fix  the  bandage  by  circular 
turns  as  for  right  breast.  On  arriving  beneath  the  left  breast 
carry  the  bandage  upward  under  the  axilla  across  the  back, 
over  the  right  shoulder  down  between  the  breasts  to  point  of 
starting.  Alternate  turns  finish  the  bandage  as  on  the  right 
side  (Fig.  46). 


36  PRACTICAL  BANDAGING 

Suspensory  of  Breast  (Fig.  47)  (Bandage  8  Yards  x  3 
Inches). — To  bandage  the  right  breast  apply  the  initial  ex- 
tremity of  the  roller  at  the  inner  and  upper  aspect  of  the 
affected  breast.  Carry  the  bandage  well  out  on  the  point 
of  the  opposite  shoulder  loop  under  the  axilla,  then  cross  the 
previous  turn  on  the  point  of  the  shoulder.  Passing  diag- 
onally down  across  the  back  around  the  side  and  under  the 


FIG.  47. — Suspensory  of  the  breast. 

affected  breast  to  point  of  starting.  Fix  with  a  second  turn 
drawing  both  snugly.  Repeat  this  figure-of-8  turn  six  or 
eight  times  overlapping  the  preceding  turns  two-thirds  of  the 
bandage  width  over  the  breast  and  four-fifths  the  width  over 
the  point  of  the  shoulder.  The  succeeding  turns  approach 
the  neck,  covering  in  the  breast  and  opposite  shoulder.  The 
bandage  is  a  poor  one. 


ROLLER  BANDAGES  37 

Suspensory  of  Both  Breasts  ( Fig.  48 )  (  Bandage  8  Yards 
x  3  Inches). — Start  the  initial  extremity  under  the  right 
breast  and  fix  by  two  circular  turns,  then  carry  the  bandage 
obliquely  up  under  the  right  breast,  and  over  the  left  shoulder, 
obliquely  across  the  back  and  under  the  right  breast,  across 


FIG.  48. — Suspensory  of  both  breasts. 

under  the  left  breast  overlapping  one-half  the  previous 
horizontal  circular  turn.  Pass,  then,  diagonally  across  and 
up  the  back  over  the  right  shoulder,  down  under  the  left 
breast  and  around  the  back  to  the  starting  point.  This  is  one 
complete  turn  which  repeated  four  or  five  times  finishes  the 
bandage.  Horizontal  turns  should  ascend  as  they  overlap 


3g  PRACTICAL  BANDAGING 

and  oblique  turns  should  advance  outward  and  upward  on  the 
breasts  as  they  overlap. 

Figure-of-8  of  the  Breasts  (Kiwisch)  (Figs.  49  and  50). 
— After  applying  two  or  three  turns  of  a  suspensory  of  both 
breasts,  cover  the  breasts  by  three  or  four  spiral  turns  and 
then  by  three  or  four  figure-of-8  turns  to  compress  the 
breasts,  passing  under  the  right  breast  over  the  left  breast, 


FIG.  49. — Figure-of-8  of  the  breast. 

around  the  back,  then  over  the  right  breast  under  the  left 
breast  and  around  back.  Repeat  three  or  four  times,  ending 
the  bandage  by  a  circular  turn  across  both  breasts. 

Desault  (Fig.  51)  Bandages  3  Rollers  Each  8  Yards  x  3 
Inches). — Pad  triangular  in  shape,  base  2  to  2^  inches,  thick- 
ness tapering  to  nothing  and  five  or  six  inches  long.  Place 
the  wedge-shaped  pad  in  the  axilla  of  injured  side.  It  should 
be  the  proper  size  to  fill  the  wedge  space  between  the  abducted 


ROLLER  BANDAGES 


39 


arm  and  the  chest.  Hold  in  place  by  ascending  spiral  turns 
of  the  thorax,  the  last  two  turns  passing  up  across  the  trunk, 
over  the  opposite  shoulder,  looping  around  the  upper  arm, 
back  over  the  shoulder  and  across  the  trunk  to  axilla  of  af- 
fected side.  The  addition  of  this  turn  completes  the  original 
Desault,  not  being  found  in  the  modified  Desault  (first 
roller).  The  arm  is  brought  against  the  pad  and  the  fore- 


FIG.  50. — Figure-of-8  of  the  breast. 

arm  to  a  right  angle.  Place  the  initial  extremity  in  axilla  of 
sound  side  and  then  by  descending  slow  spiral  turns,  each 
overlapping  one-half  the  bandage  width,  the  arm  is  bound  to 
the  side  from  the  level  of  the  anterior  axillary  fold  to  the 
bend  of  the  elbow  (second  roller). 

Third  Roller.   Place  the  initial  extremity  in  the  posterior 
aspect  of  the  sound  axilla,  then  carry  the  bandage  diagonally 


40  PRACTICAL  BANDAGING 

across  the  back  over  the  affected  shoulder,  just  grasping  the 
point  of  the  shoulder  with  the  bandage  firmly  enough  to  pre- 
vent slipping  back  or  front.  Carry  the  turn  from  here  down 
the  front  of  the  arm,  under  the  elbow  and  across  the  back 
to  the  point  of  starting.  Now  carry  the  bandage  forward 
under  the  sound  axilla,  across  the  chest,  over  the  affected 


FIG.  51. — Desault  bandage. 

shoulder  down  behind  the  arm,  under  the  elbow  in  front  of 
the  upper  part  of  the  forearm,  across  the  chest  to  the  sound 
axilla.  Three  turns,  each  covering  two-thirds  of  the  previous 
turn,  usually  suffice.  A  few  circular  turns  may  finish  the 
bandage.  The  forearm  is  slung  from  the  neck.  It  will  be 
noticed  that  the  roller  just  described  forms  a  triangle  in 


ROLLER  BANDAGES  4I 

front  and  in  back.  Its  direction  of  application  can  readily  be 
remembered  by  the  use  of  the  key  A.  S.  E.,  each  letter  rep- 
resenting one  of  the  three,  axilla,  shoulder,  elbow.  The 
original  Desault  is  composed  of  three  rollers  but  the  modified 
bandage  is  the  one  most  popular  at  the  present  day. 


FIG.  52. — Davis  bandage. 

The  modified  Desault  omits  the  first  roller,  retaining  the 
second  and  third  roller  in  detail. 

Davis  Bandage  (Fig.  52)  (Bandage  8  Yards  x  2.^/2 
Inches). — Fix  the  initial  extremity  by  passing  two  or  three 
circular  turns  around  the  lower  chest  and  right  arm,  from 
patient's  right  to  left.  On  arriving  behind  the  affected  elbow 


42  PRACTICAL  BANDAGING 

carry  the  next  turn  down  diagonally  in  front  and  around 
under  the  forearm,  to  pass  under  the  elbow  obliquely,  over 
the  front  of  the  forearm,  over  the  wrist  and  around  the  back. 
Then  pass  around  over  the  affected  elbow  in  front  of  the 
forearm  and  under  the  wrist  to  back.  Repeat  these  last  two 
turns  alternately  three  or  four  times,  overlapping  about  two- 
thirds  the  succeeding  turns,  forming  a  spica  in  front  of  the 


FIG.  53. — Velpeau  (start). 


forearm.  Finish  by  two  or  three  circular  turns  around  chest 
and  arm,  if  desired. 

To  bandage  the  left  side  apply  the  turns  as  above  except 
on  arriving  at  the  sound  side  carry  the  bandage  under  the 
forearm  in  front  of  and  around  the  lower  arm  and  elbow 
across  the  back,  then  over  and  around  the  forearm,  under  the 
elbow  and  around  the  back.  Finish  as  above. 

Velpeau  (Modified)  (Figs.  53,  54,  55  and  56)  (Bandage 
8  Yards  x  3  Inches). — Place  the  hand  of  the  affected  side,  on 
the  opposite  shoulder  thereby  bringing  the  elbow  near  the 
midline  of  the  body.  This  position  pushes  the  shoulder  up- 


ROLLER  BANDAGES  43 

ward,  outward  and  backward.  Place  the  initial  extremity  in 
the  axilla  of  the  sound  side,  posterior  aspect.  Carry  the 
bandage  across  the  back  to  a  point  well  out  on  the  shoulder, 
down  around  the  arm  about  the  position  of  the  deltoid 
tubercle.  From  liere  the  bandage  passes  behind  the  elbow,  be- 
tween it  and  the  body,  crossing  the  chest  to  the  point  of 


FIG.  54. — Velpeau. 

starting.  Fix  this  turn  by  a  similar  one,  completely  over- 
lapping it.  Then  from  the  same  point  of  starting  the  bandage 
is  carried  across  the  back  horizontally,  crossing  in  front  of 
the  elbow,  confining  the  arm  and  forearm,  but  leaving  the 
tip  of  the  olecranon  exposed.  Alternate  vertical  and  horizon- 
tal turns  are  now  employed  to  complete  the  bandage.  The 


44  PRACTICAL  BANDAGING 

vertical  turns  overlap  two-thirds  approaching  the  neck  and 
elbow  but  not  passing  over  the  point  of  the  elbow.  The 
horizontal  turns  overlap  one-half  the  previous  turns  and  are 
continued  as  high  on  the  chest  as  the  axillary  folds  will  allow. 
Another  modification  of  the  Velpeau  is  described  as  fol- 


FIG.  55. — Velpeau  (side  view). 

lows  (Fig.  57)  :  With  the  upper  extremity  in  the  same 
position  as  above,  fix  the  bandage  by  spiral  turns  around  the 
arm  and  thorax;  when  the  roller  reaches  the  axilla  of  the 
well  side  it  passes  up  across  the  back,  over  the  shoulder  well 
out  on  the  point,  down  the  front  of  the  arm,  under  the  elbow, 
up  the  back  of  the  arm,  over  the  tip  of  the  shoulder  and 


ROLLER  BANDAGES 


45 


FIG.  56. — Velpeau  (posterior  view). 


FIG.  57. — Velpeau  modified. 


46 


PRACTICAL  BANDAGING 


across  the  chest  to  the  point  of  starting.     Repeated  turns 
overlapping  upward  and  inward  accomplish  the  bandage. 

Velpeau  Modified  (Dulles)  (Fig.  58)  (Bandage  8  Yards 
x  3  Inches ) . — With  the  right  upper  extremity  in  the  Velpeau 
position  fix  the  bandage  by  two  circular  turns  just  above  the 
elbow  passing  around  the  arm,  forearm  and  chest.  On  arriv- 


FiG.  58. — Velpeau  modified  (Dulles). 

ing  in  the  sound  axilla  carry  the  bandage  obliquely  up  across 
the  back,  over  the  point  of  the  shoulder  of  the  injured  side, 
down  in  front  of  the  arm,  under  the  elbow,  up  the  back  of 
the  arm  over  the  point  of  same  shoulder,  then  diagonally 
across  the  chest  and  forearm  to  the  base  of  sound  axilla, 
finishing  with  a  circular  turn  similar  to  the  fixation  turns. 


ROLLER  BANDAGES 


47 


Repetition  of  these  turns  five  or  six  times  overlapping  about 
two-thirds  of  each  succeeding  turn  complete  the  bandage, 
bringing  the  last  turn  well  up  in  the  axilla,  close  to  the  neck, 
and  half-way  up  the  forearm. 

Figure-of-8  of  the  Head  and  Neck  (Fig.  59)  (Bandage  3 
Yards  x  2  Inches). — Fix  the  initial  extremity  around  fore- 
head and  just  below  the  occiput.  On  arriving  below  the  left 
ear  the  second  time,  drop  down  below  the  occiput,  around  the 
neck  and  back  to  below  the  occiput.  From  here  carry  the 


FIG.  59. — Figure-of-8  of  the  head  and  neck. 


FIG.  60. — Barton  bandage. 


bandage  over  right  ear  around  forehead  over  left  ear,  back 
to  just  below  occiput.  Repeat  this  figure-of-8  turn  two  or 
three  times,  overlapping  upward  or  downward  as  desired. 
The  bandage  may  be  applied  without  the  fronto-occipital  cir- 
cular turns. 

Barton  Bandage  (Fig.  60)  (Bandage  5  Yards  x  2 
Inches). — Place  the  initial  extremity  on  the  nape  of  the  neck 
just  behind  and  below  the  left  ear.  Carry  the  bandage  be- 
neath the  occipital  protuberance  between  the  opposite  ear  and 
the  parietal  eminence,  thence  obliquely  over  the  head  to  mid- 


48  PRACTICAL  BANDAGING 

line  anterior  to  the  highest  point  of  scalp.  From  here  pass 
down  the  left  side  of  the  head  and  face  under  the  chin  up 
beside  the  face,  crossing  the  previous  turn  in  the  middle  line 
on  top  of  the  head.  It  is  next  carried  between  the  left 
parietal  eminence  and  ear  to  point  of  starting,  when  a  turn 
is  made  horizontally  around  front  of  the  chin.  Three  such 
complete  turns  usually  suffice,  each  exactly  covering  the  last. 
A  modified  "Barton"  (see  dotted  line)  is  described  start- 
ing with  two  circular  occipito frontal  turns,  then  passing  from 


FIG.  61.— Gibson  bandage. 

occiput  down  under  the  ear  around  the  chin  and  back  to  occi- 
pital protuberance.  From  here  the  bandage  is  similar  to  the 
original  "  Barton."  Except  that  two  more  occipito  frontal 
turns  complete  it. 

Gibson  Bandage  (Fig.  61)  (Bandage  5  Yards  x  2 
Inches). — Place  the  initial  extremity  on  the  right  temple  and 
carry  the  roller  over  the  front  of  the  top  of  the  head,  down 
over  the  opposite  temple,  under  the  chin  and  up  to  the  start- 
ing point.  Add  two  more  similar  turns  exactly  overlapping. 
When  at  the  right  temple  again,  reverse,  and  carry  the  band- 


ROLLER  BANDAGES  49 

age  around  the  head  and  forehead,  just  above  the  ears.  Re- 
peat this  turn  twice.  From  a  position  above  the  right  ear 
carry  the  bandage  posterior,  under  the  occipital  protuberance 
and  then  around  the  anterior  aspect  of  the  chin.  Repeat  this 
turn  twice.  Returning  to  the  nape  of  the  neck  a  reverse  is 
made  and  the  bandage  carried  over  the  centre  of  the  head  to 
end  on  the  horizontal  turns  in  the  centre  of  the  forehead. 
Pin  all  intersections.  This  bandage  is  poor  and  seldom  used. 


FIG.  62. — Oblique  of  the  jaw  (reverse  side).      FIG.  63. — Oblique  of  the  jaw  (right  side). 

Oblique  of  the  Jaw  (Figs.  62  and  63)  (Bandage  5  Yards 
x  2  Inches). — To  bandage  the  right  side  of  the  jaw,  place  the 
initial  extremity  on  the  right  temple  and  carry  the  bandage 
by  two  circular  turns  from  before  backward  around  the  head 
and  forehead  above  the  ears.  On  the  third  arrival  over  the 
right  ear  carry  the  bandage  down  under  the  occipital  pro- 
tuberance, around  under  the  jaw  and  up  the  right  side  of  the 
face,  having  the  anterior  edge  of  the  bandage  just  posterior  to 
the  outer  angle  of  the  eye.  Thence  it  is  carried  over  the  head 
and  down  back  of  the  left  ear,  under  the  jaw  and  again  up  the 
right  side  of  the  face  posterior  to  the  first  turn  and  over- 
4 


50  PRACTICAL  BANDAGING 

lapping  it  one-half  on  the  affected  side  and  exactly  covering 
the  previous  turn  on  the  sound  side.  Repeat  two  or  three 
times  and,  on  arrival  above  the  left  ear,  reverse  the  bandage 
and  carry  around  the  head  in  circular  turns  immediately  over 
the  fixation  turns.  Instead  of  reversing  above  the  left  ear 
the  last  turn  may  be  carried  under  the  chin,  below  the  right 
ear,  around  under  the  occiput,  ending  in  circular  turns  over- 
lapping the  fixation  turns.  The  bandage  of  the  left  side 


FIG.  64. — Double  oblique  of  the  jaw. 

of  the  jaw  is  started  over  the  left  temple  and  carried  back- 
ward in  circular  turns.  From  this  point  the  bandages  are 
identical. 

Double  Oblique  of  the  Jaw  (Fig.  64)  (Bandage  5  Yards 
x  2  Inches. — Place  the  initial  extremity  on  the  right  temple 
and  fix  by  one  or  two  fronto-occipital  turns.  On  arriving 
above  the  left  ear,  drop  down  across  the  back  of  the  neck, 
under  the  right  ear,  under  the  chin,  and  then  carry  it  up  the 
left  side  of  the  face  just  back  of  external  angle  of  the  eye. 
Carry  the  bandage  over  the  front  of  the  head,  between  parietal 
eminence  and  the  right  ear,  down  back  of  the  neck,  under 
the  left  ear,  under  the  chin,  up  the  right  side  of  the  face, 


ROLLER  BANDAGES  SI 

just  back  of  the  external  angle  of  the  eye,  across  the  front 
part  of  the  head  crossing  the  previous  turn  in  the  midline, 
back  over  the  left  ear  to  the  nape  of  the  neck.  Repeat  these 
turns  two  or  three  times,  exactly  overlaying  the  preceding 
turns  except  the  turn  at  the  side  of  the  face  where  they  over- 
lap two-thirds  or  more  in  a  backward  direction.  End  the 
bandage  by  one  or  more  fronto-occipital  turns. 


FIG.  65. — Recurrent  of  the  scalp  (first  step). 


FIG.  66. — Recurrent  of  the  scalp. 


Recurrent  of  the  Scalp  (Figs.  65  and  66)  (Bandage  5 
Yards  x  2  Inches). — Fix  the  bandage  by  one  or  two  circular 
turns,  horizontally  around  the  head,  above  the  eyebrows  and 
ears  but  below  the  occipital  protuberance.  This  is  important 
to  give  support  to  the  bandage  and  prevent  displacement  up- 
wards. On  arriving  at  the  occiput,  reverse,  and  carry  the 
bandage  over  the  middle  of  the  head  and  to  midpoint  on  the 
circular  turns  in  front.  Again  reverse  and  carry  back  to  the 
occiput  covering  in  one-half  of  the  first  turn.  Continue  to 
carry  it  backward  and  forward  on  alternate  sides  of  the  head 


52  PRACTICAL  BANDAGING 

until  the  scalp  is  covered,  when  the  bandage  is  completed  by 
two  circular  turns.  In  the  application  of  the  recurrent  turns, 
the  turns  must  of  necessity  be  held  front  and  back  until  the 
circular  turns  can  bind  them  in  place. 

Transverse  Recurrent  of  the  Scalp  (Fig.  67)  (Bandage  3 
Yards  x  2  Inches). — Fix  the  initial  extremity  over  one  ear 
by  two  occipitof rontal  turns.  On  arriving  again  over  the  left 
ear,  reverse  the  bandage,  carry  directly  over  the  vertex  to 
just  below  the  right  ear.  Here,  again,  reverse  and  carry  back 


f 

FIG.  67. — Transverse  recurrent  of  the  scalp  (first  steps). 

to  above  the  left  ear  covering  in  one-half  the  previous  turn. 
Continue  such  recurrent  turns  alternately  proceeding  toward 
the  forehead  and  toward  the  occiput  until  the  entire  scalp 
is  covered  and  the  last  turns  develop  into  circular  turns,  cover- 
ing the  fixation  turns.  The  recurrent  turns  must  be  held  on 
both  sides  by  operator  and  an  assisting  hand  until  the  final 
circular  turns  bind  them  in  position. 

Recurrent  of  Scalp  with  Double  Roller  (Fig.  68)  (Band- 
age 5  Yards  x  2  Inches). — The  centre  of  the  roll  is  placed  on 
the  forehead  and  the  two  ends  carried  back  to  the  occiput. 


ROLLER  BANDAGES  53 

Here  the  left  hand  roller  crossing  under  the  right  hand  roller 
is  reversed  and  carried  over  the  centre  of  the  scalp  to  the  root 
of  the  nose.  It  is  crossed  here  by  the  right  hand  roller  which 
has  made  a  circular  turn  overlapping  the  fixation  turns. 
Again  reversing  the  original  left  hand  roller,  recurrent  turns 
are  made  alternate  on  each  side  the  scalp,  each  loop  being 
caught  by  the  right  hand  or  circular  roller.  Continue  such 
recurrent  turns  until,  overlapping  two-thirds  the  bandage 


FIG.  68. — Recurrent  of  the  scalp  with  double  roller. 

width,  the  entire  scalp  is  covered.  Then  the  smaller  roller 
is  cut  and  the  larger  one  takes  two  extra  circular  turns.  The 
double  roller  has  the  advantage  over  the  single  in  that  one 
pair  of  hands  can  apply  it. 

Monocle  or  Crossed  Bandage  of  One  Eye  (Fig.  69) 
(Bandage  5  Yards  x  2  Inches). — To  bandage  the  left  eye,  fix 
the  initial  extremity  on  the  left  temple  by  a  circular  turnaround 
the  head  from  left  to  right.  When  the  roll  is  above  the  right 
ear,  incline  the  bandage  down  behind  the  head,  under  the  left 
ear  and  across  the  left  eye,  the  lower  edge  of  the  bandage 
crossing  the  root  of  the  nose.  It  next  passes  over  the  right 


54 


PRACTICAL  BANDAGING 


side  of  the  top  of  the  head  and  down  to  the  back  of  the  neck. 
Repeat  this  turn  two  or  three  times  overlapping  one-half  the 
width  of  the  bandage,  ascending  on  the  cheek  and  descending 
on  the  scalp.  Finish  with  a  circular  turn  around  the  head. 

Binocular  or  Crossed  Bandage  of  Both  Eyes  (Fig.  70) 
(Bandage  5  Yards  x  2  Inches) . — Bandage  the  left  eye  as  just 
described  and  after  finishing  the  circular  turn,  pin  it  at  the 
back  of  the  head.  Then  bring  it  up  over  the  left  side  of  the 


FIG.  69. — Crossed  bandage  of  the  eye. 


FlG.  70. — Crossed  bandage  of  both  eyes. 


head,  down  across  the  root  of  the  nose,  over  the  right  eye, 
low  on  the  cheek,  and  under  the  right  ear,  back  to  the  occiput. 
Finish  just  as  in  the  left  eye. 

Both  eyes  can  be  bandaged  simultaneously.  After  applying 
the  first  turn  crossing  the  left  eye,  carry  the  bandage  around 
the  head  above  the  ears,  then  down  across  the  root  of  the 
nose,  across  the  cheek  covering  the  ear.  Then  a  full  turn 
around  the  head.  Repetition  completes  bandage  (Fig.  70). 

The  binocle  can  be  applied  with  the  double  roller,  carrying 
the  rollers  each  back  over  an  ear  crossing  posteriorly  and  re- 
turning on  opposite  sides  under  the  ears,  again  crossing  each 
other  at  the  root  of  the  nose. 


PART  II 


MISCELLANEOUS  BANDAGES 

Tailed  Bandages  (Figs  71,  a  and  b,  and  72) . — These  may 
be  three  tailed,  or  the  "  T  "  bandage,  the  four  tailed  and  the 
many  tailed. 

Perineal  "T"  Bandage  (Fig.  71,  a). — One  example  of 
the  "  T  "  bandage  consists  of  a  narrow  strip  long  enough  to 
more  than  encompass  the  waist  and  usually  2^/2  inches  to  3 


a 
FIG.  71.- 


"T"  bandage;  b,  four-tailed  bandage. 


inches  wide.  At  this  centre  is  sewed  a  similar  strip  three  or 
four  inches  wide  making  the  stem  of  the  "  T."  This  is  split 
at  its  free  end  for  a  short  distance,  to  enable  it  to  be  easily 
torn.  It  is  used  to  hold  dressings  against  the  perineum. 
The  cross  bar  of  the  "  T  "  goes  around  the  waist  with  the 
stem  posterior,  from  which  position  it  is  brought  through 
the  perineum  and  torn  down  the  desired  length  to  pass  on  each 
side  of  the  genitals.  The  two  ends  are  tied  together  around 

55 


PRACTICAL  BANDAGING 


FIG.  72. — "T"  bandage  of  the  perineum. 


FIG.  73. — Modified  "T"  bandage  of  the  perineum. 

the  waist,  like  a  belt,  and  the  two  perineal  strips  brought  up 
and  tied  to  the  belt  (Fig.  72). 

Perineal  Bandage  (Cunningham)    (Figs.  73  and  74).— 


MISCELLANEOUS  BANDAGES 


57 


This  consists  of  a  waist  band  48  inches  long  and  3  to  5  inches 
wide.  To  the  centre  of  this  and  at  right  angles  to  it  are 
sewed  one  upon  the  other  two  strips,  4  inches  wide  and  36 
to  40  inches  long.  The  anterior  strip  is  split.  The  belt  is 
applied  around  the  waist  and  tied  in  front,  the  split  strips 
crossed  in  the  perineum  behind  the  elevated  scrotum  and 
tied  or  pinned  to  the  belt.  The  untorn  strip  is  then  brought 
up  covering  the  penis  and  scrotum  and  fastened  to  the  belt. 


FIG.  74. — Modified  "T"  bandage  of  perineum. 

The  "T"  Bandage  of  the  Scalp  (Fig.  75)  (Bandage 
Width  2  to  3  Inches). — With  the  junction  of  the  stem  and  bar 
of  the  "  T  "  over  the  forehead,  side  of  head  or  the  occiput, 
the  horizontal  limb  is  carried  around  the  forehead  and  occiput 
just  above  the  ears.  The  stem  is  carried  across  the  top  of 
the  head  and  the  three  ends  tied  or  pinned  together. 

The  "  T  "  Bandage  of  the  Eye  (Fig.  76).— Into  the  angle 
between  the  stem  and  the  bar  of  the  "  T  "  sew  a  right  angle 


5g  PRACTICAL  BANDAGING 

triangle  of  gauze  or  muslin,  cut  the  size  and  shape  to  suit  the 
case.  Carry  the  limbs  of  the  bar  around  the  head  above  the 
ears,  and  the  stem  under  the  chin  and  up  the  opposite  side 


FIG.  75. — "T"  bondage  of  the  scalp. 


FIG.  76. — "T"  bandage  of  the  eye. 


FIG.  77. — "X"  bandage  of  the  ear. 


of  the  face  to  meet  and  be  attached  to  the  horizontal  ends 
by  pin  or  knot. 

The  "T"  Bandage  of  the  Ear  (Fig.  77). — Sew  across 
the  junction  of  the  two  limbs  a  triangle  of  fabric,  equilateral 


MISCELLANEOUS  BANDAGES 


59 


in  type,  cut  to  suit  the  case.  Pass  the  horizontal  limbs  around 
the  head  above  the  ears  and  the  stem  under  the  neck  to  meet 
the  horizontal  limbs.  Fasten  the  three  ends  by  tying  or 
pinning. 

Bandages  of   similar  construction  can   be  fitted  to  the 
groin,  buttock,  and  scrotum  (Figs.  78  and  79). 


FIG.  78. — "  T  "  bandage  of  the  groin. 


FIG.  79. — "  T  "  bandage  of  the  buttock. 


FIG.  80. — Double  "T"  of  chest. 

The  Double  "  T  "  of  the  Chest  (Fig.  80). — The  best  ex- 
ample of  this  is  the  Murphy  binder  made  of  the  shape  and 
dimensions  shown  in  Fig.  80.  A  simpler  dressing  is  made  by 
taking  a  strip  of  material  8  to  10  inches  wide  and  long 
enough  to  encompass  the  chest  easily.  Four  inches  from  the 


6o 


PRACTICAL  BANDAGING 


centre  of  one  edge,  two  strips/  two  inches  wide  and  twelve 
inches  long,  are  sewn  one  on  each  side  of  the  centre.  The 
wide  strip  passes  around  the  chest  well  up  in  the  axilla  and 
the  two  strips  pass  over  the  shoulders  and  are  attached  to  the 
upper  edge  of  the  wide  strip  opposite. 

The  Four-tailed  Bandage  of  Chin  (Fig.  81). — This  is 
made  by  tearing  a  piece  of  material  the  desired  width,  and 
two  or  three  feet  long,  one-third  or  three- fourths  the  distance 
from  its  middle  point  to  the  end.  Its  chief  use  is  for  a 


FIG.  8 1. — Four-tailed  bandage  of  the  chin. 


FIG.  82. — Four-tailed  bandage  of  the  nose 
and  lip. 


fractured  inferior  maxilla.  The  untorn  portion  is  placed  on 
the  chin  and  the  two  upper  ends  tied  behind  the  neck,  while 
its  lower  ends  are  tied  over  the  head.  Then  tie  the  ends 
from  the  knot  on  top  of  the  head  to  the  ends  from  the  knot 
back  of  the  neck. 

Four-tailed  Bandage  of  the  Nose  and  Upper  Lip  (Fig. 
82). — A  piece  of  material,  preferably  gauze,  three  inches 
wide  and  two  feet  long  is  torn  down  both  ends  to  within  an 
inch  of  the  centre.  The  body  of  the  bandage  is  placed  over 
the  nose  and  lip,  the  ends  carried  back,  the  upper  ones  tied 


MISCELLANEOUS  BANDAGES 


6l 


at  the  back  of  the  neck  and  the  lower  ones  tied  back  of  the 
head. 

Quadrangle  Bandage  of  Occiput  (Fig.  83). — A  piece  of 
material,  4  to  5  inches  wide  and  26  to  30  inches  long,  is  torn 
down  the  centre  of  each  end,  one-third  the  length  of  the  entire 
strip.  The  untorn  portion  is  placed  over  the  occiput  and  the 
torn  ends  are  crossed  on  each  side.  The  two  upper  ends  are 
tied  under  the  jaw  and  the  two  lower  ends  are  tied  across  the 


FIG.  83. — Quadrangle  bandage  of  the 
occiput. 


FIG.  84. — Quadrangle  bandage  of  the 
vertex. 


forehead.     The  dressing  may  be  so  cut  as  to  leave  the  ears 
uncovered. 

Quadrangle  Bandage  of  the  Vertex  (Fig. 84). — This  band- 
age is  similar  in  construction  to  that  of  the  occiput.  Its  body 
or  untorn  portion  is  placed  over  the  vertex,  while  its  front 
ends  are  passed  above  the  ears  and  tied  under  the  occiput, 
the  back  ends  cross  over  these  and  are  tied  under  the  jaw. 

Quadrangle  Bandage  of  Neck  (Fig.  85). — Similar  in 
construction  to  the  above  bandage.  The  body  is  placed  well 
down  on  the  nape  of  the  neck  and  the  ends  tied  as  in  figure. 

Quadrangle  Bandage  or  Sling  of  the  Shoulder  (Fig.  86). 


62 


PRACTICAL  BANDAGING 


—A  piece  of  material  6  to  8  inches  wide  and  long  enough  to 
more  than  encompass  the  shoulder  and  chest  is  torn  down  its 
centre  from  each  end  to  within  4  or  5  inches  of  its  centre. 
The  body  of  the  sling  is  placed  over  the  shoulder,  the  two 


FIG.  85. — Quadrangle  bandage  of  the  neck 


FIG.  86. — Quadrangle  bandage  of  the  shoulder. 


FIG.    87. — Quadrangle   bandage  of  the 
arm  and  forearm. 


upper  ends,  carried  one  around  each  side  of  the  thorax,  are 

tied  under  the  opposite  axilla,  the  two  lower  ends  are  crossed 

under  the  axilla  of  the  affected  side  and  tied  around  the  arm. 

Quadrangle  Bandage  or  Sling  of  Arm  and  Forearm  (Fig. 


MISCELLANEOUS  BANDAGES  63 

87). — A  piece  of  material,  10  to  12  inches  wide,  is  prepared 
as  in  the  sling  of  the  shoulder.  A  slit  is  cut  in  the  centre 
of  the  body  to  receive  the  point  of  the  elbow.  The  upper 
ends  pass  directly  around  the  trunk  and  are  fastened  under 
the  opposite  arm.  The  lower  ends  are  carried  diagonally 
across  the  trunk  and  fastened  over  the  opposite  shoulder. 

Many  Tailed  Bandages  (Scultetus)  (Fig.  88). — This 
consists  of  a  piece  of  muslin  or  gauze  of  the  desired  width 
and  long  enough  to  more  than  surround  the  part.  Into  each 
end,  tears  are  made  about  2  inches  apart  for  a  distance  of  a 


FIG.  88. — Many  tailed  bandages. 

few  inches.  It  is  used  to  retain  dressings  that  need  frequent 
changing  and  is  applied  under  the  part,  the  tails  being  brought 
up  on  each  side  and  each  corresponding  pair  tied,  the  lowest 
pair  is  first  tied  in  a  single  knot  and  the  end  tucked  under  the 
next  pair  which  is  tied  down  and  so  on  until  the  last  pair  is 
reached  and  tied  by  a  bow  knot.  The  opposite  ends  may  be 
overlapped  and  each  pair  pinned  with  a  safety  pin,  rather 
than  tied. 

Swathes. — Are   merely   wide   pieces    of   cloth   that   are 
used  to  go  around  a  part,  and  are  fastened  with  pins.     A 


64  PRACTICAL  BANDAGING 

common  swathe  is  used  to  retain  an  upper  extremity  in  the 
acutely  flexed  position  (Fig.  89).  A  piece  of  cotton  or  gauze, 
the  width  of  the  shoulder  from  base  of  neck  to  acromion  and 
long  enough  to  make  a  figure-of-8  around  the  flexed  elbow 
and  body,  is  passed  horizontally  between  the  flexed  elbow  and 
body,  with  its  middle  opposite  the  elbow.  The  front  end  is 


FIG.  89. — Swathe. 

now  carried  up  around  the  forearm  and  over  the  shoulder  of 
the  affected  side,  diagonally  across  the  back  and  under  the 
axilla  of  the  opposite  side.  Here  it  is  pinned  to  the  other 
end  which  has  been  brought  over  in  front  of  the  flexed 
extremity.  The  latter  end  is  continued  as  a  circle  about  the 
thorax  posteriorly  and  is  pinned  to  the  part  surrounding  the 
flexed  arm.  This  dressing  is  a  very  excellent  one  for  use  in 


MISCELLANEOUS  BANDAGES  65 

fractures  and  injuries  in  and  immediately  around  the  elbow- 
joint. 

Handkerchief  Bandages  (Fig.  90,  a). — Handkerchief 
bandages  are  made  of  handkerchiefs  or  other  material  in  the 
shape  of  a  square  which  varies  in  size  to  suit  the  need.  The 
sides  of  the  square  are  usually  20  to  24  inches  long.  This 
folded  once  in  the  form  of  a  right  angle  triangle  constitutes 
the  handkerchief  or  triangle  bandage  commonly  known  as  a 
"  sling."  When  folded  repeatedly  on  itself  in  the  same  direc- 


FIG.  90. — Handkerchief  a,  cravat  b. 

tion  it  becomes  the  "'cravat"  bandage   (Fig.  90,  b).     The 
materials  used  are  silk,  gauze,  muslin,  light  duck  and  linen. 

The  handkerchief  bandage  is  the  most  adaptable  of  all 
the  forms  of  bandages.  It  can  be  substituted  for  the  roller 
bandage  and  the  tailed  bandages  and  can  be  used  as  a  torni- 
quet.  Its  chief  usefulness,  is  as  a  sling  in  emergency  dressing, 
(for  handkerchiefs  are  almost  everywhere  obtainable)  and  to 
retain  cumbersome  dressings  that  demand  frequent  changing. 

The  long  side  of  the  triangle  is  its  base,  the  right  angle 
is  the  apex  and  the  acute  angles  make  the  extremities  or  ends 
of  the  bandage. 
5 


66 


PRACTICAL  BANDAGING 


When  the  bandage  is  applied  it  derives  its  name  from  the 
part  of  the  anatomy  with  which  its  base  comes  in  contact. 
The  ends  are  usually  knotted  preferably  with  a  flat  or  reef 
knot  so  placed  as  to  make  the  least  possible  pressure. 

Occipitof rental  Triangle  (Fig.  91)  (Bandage  Base  30 
Inches). — Place  the  base  of  the  triangle  just  below  the  most 
prominent  part  of  the  back  of  the  head,  draw  the  apex  for- 
ward and  down  over  the  forehead.  Draw  the  ends  a'round 
the  head  over  the  ears  and  knot  over  the  forehead.  Turn 


FIG.  91. — Occipitof rental  triangle. 


FIG.  92. — Fronto-occipital  triangle. 


the  apex  up  over  the  knot  and  pin  it.  By  drawnig  the  sides 
of  the  apex  snugly  down  over  the  both  ears  you  have  two 
secondary  apices  which  may  be  turned  up  and  pinned  (  dotted 
line). 

Fronto-occipital  Triangle  (Fig.  92). — Similar  to  the  one 
above  except  it  is  applied  from  before,  backward. 

Bitemporal  Triangle  (Fig.  93). — This  also  is  similar  to 
above,  differing  only  in  that  it  is  applied  with  the  base  over 
the  temporal  region. 

Verticomental  Triangle  (Fig.    94)     (Bandage    Base    36 


MISCELLANEOUS  BANDAGES  67 

Inches). — The  base  is  placed  on  the  front  of  the  top  of  the 
head  and  the  apex  is  carried  back  to  the  nape  of  the  neck. 
The  ends  are  carried  down  one  on  each  side  of  the  face, 
crossed  under  the  jaw  then  drawn  around  the  neck  on  each 
side  and  tied  over  apex.  The  apex  is  turned  up  and  pinned. 
Auriculo-occipital  Triangle  (Fig.  95). — Place  the  base 
of  the  triangle  on  the  side  of  the  face  in  front  of  the  ear, 
the  apex  pointing  backward.  Carry  the  ends  to  the  opposite 


FIG.  93. — Bitempora!  triangle. 


FlG.  94. — Verticomental  triangle. 


side  in  front  of  the  ear.  The  apex  is  brought  around  the 
back  of  the  head  and  folded  back  over  the  two  ends  which  are 
united  over  it.  Pin  the  apex  back. 

The  Triangle  of  the  Head  (Figs.  96  a  and  b)  (Hunter's 
Cap.). — Square  of  material  28  inch  side.  Fold  the  hand- 
kerchief across  one  inch  from  its  middle.  With  the  shorter 
side  under,  turn  the  corners  of  the  folded  edge  in  to  meet 
each  other.  With  the  extremities  of  the  large  triangle  held 
on  the  stretch,  roll  the  base  of  the  triangle  upon  itself  as  far 
as  the  edge  of  the  shorter  posterior  layer.  Lift  the  bandage 
and  on  relaxing  the  tension  the  two  layers  will  separate. 


68 


PRACTICAL  BANDAGING 


Apply  the  single  posterior  layer  over  the  head,  with  the  edge 
surrounding  the  face.  The  rolled  edge  is  pulled  down  around 
the  back  of  the  neck  and  the  ends  tied  under  the  jaw. 


FIG.  95. — Auriculo-occipital  triangle. 


FIG.  960. — Hunter's  cap. 


FIG.  966. — Hunter's  cap. 


Square  Cap  of  the  Head  (Figs.  97  a,  b  and  c). —  ( I  )    Use 
a  handkerchief  with  sides  long  enough  to  tie  over  the  vertex 


MISCELLANEOUS  BANDAGES 


60 


and  under  the  chin.    Fold  it  across  an  inch  from  its  centre  and 
place  it  over  the  top  of  the  head  with  the  free  edges  over 


FIG.  970.— Square  bandage  of  the  head  FIG.  97&.— Square  banaage  of  the  head 

(method  i).  (method  2). 


\ 


FIG.  97c. — Square  bandage  of  the  head  (method  3). 

the  forehead,  the  longer  one  being  next  the  scalp.  Tie  the 
two  outer,  corners  under  the  chin.  The  two  inner  corners 
are  pulled  forward  until  the  posterior  edge  fits  snugly  to  the 


70  PRACTICAL  BANDAGING 

back  of  the  neck.     Fold  the  two  corners  back  one  on  each 
side  of  the  head,  in  the  form  of  triangles,  and  pin  or  tie. 

(2)  Similar  square  and  placed  as  the  one  above.     The 
free  ends  are  twisted  until  the  dressing  is  snug  and  then  tied 
together  under  the  chin. 

(3)  Likewise  similar  to  the  one  above  except  that  the 
two  anterior  corners  are  tied  together  and  the  two  posterior 
corners  are  tied  together. 

Posterior  Triangle  of  Shoulders  (Fig.  98)  (Handkerchief 
with  Base  40  to  42  Inches  Long). — Apply  the  centre  of  the 


FIG.  98. — Posterior  triangle  of  the  shoulders.          FIG.  99. — Thoracicoscapular  triangle. 

base  back  of  the  neck,  allowing  the  apex  to  drop  down  be- 
tween the  shoulders.  The  ends  are  crossed  over  the  chest  and 
carried  under  the  axillae  and  fastened  together  over  the  apex 
which  is  turned  up  and  pinned  on  itself. 

The  Thoracicoscapular  Triangle  (Fig.  99). — Place  the 
base  of  a  large  triangle  low  down  on  the  chest  with  apex 
thrown  over  the  desired  shoulder.  Carry  the  extremities 
around  the  chest  and  fasten  together  over  the  apex  which  is 
turned  up  and  pinned  back  upon  itself.  The  excess  of  free 
edge  on  one  side  of  the  triangle  is  lapped  and  pinned. 

By  splitting  the  apex  and  carrying  one  over  each  shoulder 


MISCELLANEOUS  BANDAGES  ^ 

the  bandage  can  be  made  to  serve  double  duty.  The  slack 
on  each  can  be  taken  up  and  pinned. 

Thoracicohumeral  Triangle  (Fig.  100). — Place  the  centre 
of  the  base  of  the  triangle  around  the  affected  arm,  just  above 
the  elbow,  apex  pointing  to  the  shoulder.  Carry  the  ex- 
tremities around  the  chest  and  tie.  Draw  the  apex  well  up 
on  the  shoulder,  tuck  in  on  one  side,  fold  down  and  pin  front 
or  back. 

Triangle  Suspensory  of  the  Breasts  (Fig.  101)  (Single). 
— Place  the  base  of  a  large  triangle  with  its  centre  under  the 


FIG.  100. — Thoracicohumeral  triangle.        FIG.  101. — Triangle  suspensory  of  the  breast. 

inner  aspect  of  the  affected  breast,  the  apex  passing  up  over 
the  breast  and  shoulder  and  dropping  posterior.  Pass  the 
two  ends  one  under  the  corresponding  axilla,  the  other  over 
the  opposite  shoulder.  Fasten  together  posteriorly  over  the 
apex  which  is  turned  back  and  pinned.  ( Fig.  102. )  (  Double. ) 
Separate  the  layers  of  the  apex  and  carry  one  over  each 
shoulder  and  after  lengthening  by  a  strip  of  bandage  fasten 
under  the  united  extremities. 

Brachiocervical  Triangle  (a)  (Fig.  103). — With  the  arm 
held  at  the  side,  flex  the  forearm  at  right  angles  and  place 
the  base  of  a  large  triangle  around  the  wrist  with  the  apex 


72  PRACTICAL  BANDAGING 

toward  the  elbow.  Carry  the  anterior  extremity  around  the 
opposite  side  and  the  posterior  extremity  around  the  cor- 
responding side  of  the  neck  and  fasten  so  as  the  knot  is 


FIG.  102. — Triangle  suspensory  of  both 
breasts. 


FIG.  103. — Brachiocervical  triangle  or 
sling. 


FIG.  104. — Brachiocervical  triangle  sling.        FIG.  105. — Brachioscapuiar  triangle  sling. 

placed  on  one  side  of  the  neck.    The  apex  is  tucked  under  or 
brought   forward  and  pinned  around  the  arm. 

Brachiocervical  Triangle  (&)  (Fig.  104). — Flex  the  fore- 
arm into  the  acute  position.     Place  the  triangle  between  the 


MISCELLANEOUS  BANDAGES 


73 


arm  and  the  chest  with  the  base  passing  diagonally  across 
the  axilla  of  the  affected  side  and  the  apex  hanging  down 
over  the  chest  The  upper  extremity  passes  over  the  shoulder 
of  the  injured  side.  Bring  the  lower  extremity  around  the 
outside  of  the  arm  and  elbow  and  carry  it  over  the  sound 
shoulder  to  be  tied  to  the  upper  extremity  posteriorly.  The 
apex  is  brought  up  around  the  forearm  and  pinned  high  up 
on  the  upper  extremity. 

Brachioscapular  Triangle  (a)    (Fig.  105). — For  suspen- 
sion  from   the  uninjured  side,   the  posterior  extremity   is 


FIG.  io6.: — Brachioscapular  triangle  sling.         FIG.  107. — Brachioscapular  triangle  sling. 

carried  over  the  uninjured  shoulder,  the  anterior  extremity 
placed  under  the  axilla  of  the  injured  side  and  the  two  knotted 
together  posteriorly.  The  apex  is  folded  around  the  arm  and 
pinned.  Second  method  differs  from  the  above  only  in  that 
the  posterior  extremity  is  carried  back  of  the  chest. 

Brachioscapular  Triangle  (&)  (Fig.  106). — First  method: 
For  suspension  from  the  injured  side.  The  only  change  is  in 
having  the  posterior  extremity  pass  over  the  shoulder  of  the 
injured  side.  However,  a  further  roller  or  cravat  is  usually 
needed  to  fasten  the  knotted  ends  to  the  neck  to  prevent  its 
slipping  from  the  shoulder. 

Second  method   (c)    (Fig.   107)  :  Place  the  base  of  the 


74 


PRACTICAL  BANDAGING 


triangle  around  the  trunk  a  little  above  the  level  of  the  flexed 
forearm,  and  tie  posteriorly.  The  apex  which  has  been 
dropped  down  anteriorly  is  looped  up  enclosing  the  forearm 
and  lower  arm  and  carried  over  the  corresponding  shoulder  to 
be  lengthened  by  a  roller,  if  necessary,  to  meet  the  united 
extremities  posteriorly. 

Third  method  (d)  (Fig.  108)  :  Place  the  base  of  the 
triangle  obliquely  under  the  wrist  and  carry  the  posterior  apex 
under  the  opposite  axilla,  the  anterior  being  looped  up  over 


FIG.  1 08. — Brachioscapular  triangle  sling. 


FIG.  109. — Mayor's  bandage. 


the  forearm  and  elbow,  then  carried  over  the  corresponding 
shoulder  to  be  tied  to  its  fellow  posteriorly.  Tuck  the  fulness 
of  the  bandage  back  of  the  arm  and  bring  the  apex  forward  to 
be  pinned. 

Mayor's  Bandage  (Fig.  109). — Flex  the  forearm  at  a 
right  angle  and  bind  the  arm  to  the  chest  by  tying  the  two 
extremities  of  the  handkerchief  triangle  around  the  chest 
and  arm  just  above  the  elbow,  allowing  the  two  folds  of  the 
apex  to  hang  down  in  front.  Carry  both  folds  of  the  apex 
up  behind  the  forearm,  the  under  one  passing  over  the  sound 
shoulder  and  the  upper  one  over  the  affected  shoulder.  Fasten 


MISCELLANEOUS  BANDAGES 


75 


a  piece  of  roller  bandage  to  one  apex,  carry  it  down  the  back 
around  the  untied  extremities  and  fold  up  to  be  fastened  over 
the  opposite  shoulder  to  the  other  apex.  This  dressing  con- 
stricts the  wrist  with  the  hand  left  hanging.  It  is  better  to 
retain  the  hand  in  the  bandage. 

Modification  of  Mayor's  Bandage  (Fig.  no). — Place  the 
handkerchief  triangle  base  on  the  chest  and  tie  the  extremities 


FIG.  no. — Modification  of  Mayor's  bandage. 


FIG.  in. — Shoulder  triangle. 


behind  the  back,  the  folds  of  the  apex  hanging  down  in  front. 
Carry  the  top  fold  beneath  the  forearm  and  arm  over  the 
opposite  shoulder.  Carry  the  under  fold  over  the  forearm 
and  arm  and  up  over  the  other  shoulder.  Loop  a  piece  of 
roller  bandage  under  the  united  extremities  and  fasten  an  end 
to  each  apex  fold. 

Shoulder  Triangle  (Fig.  ill). — Place  the  base  of  the 
triangle  over  the  point  of  the  shoulder  letting  the  apex  fall 
down  the  arm.  Carry  the  extremities  around  the  shoulder 


76 


PRACTICAL  BANDAGING 


under  the  axilla,  cross  and  bring  them  around  the  arm,  tie 
them  over  the  apex  back,  and  pin. 

Hand  Triangle  (Fig.  1 12). — Place  the  base  of  the  triangle 
on  the  palmar  aspect  of  the  wrist.  Carry  the  apex  under  the 
palm  around  the  finger  ends  and  up  to  the  dorsum  of  the 
wrist.  Carry  the  two  extremities  around  the  wrist  and  hand, 
fold  the  apex,  if  long  enough,  back  upon  them  and  tie. 

Anterior  Pelvic  Triangle  (Fig.  113). — With  the  base  of 
the  triangle  up  and  the  apex  hanging  down  in  front,  fasten 
the  two  extremities  around  the  brim  of  the  pelvis.  Carry  the 


FIG.  112. — Hand  triangle. 


FIG.  113. — Anterior  pelvic  triangle. 


apex  over  the  genitalia  through  the  perineum  and  up  pos- 
teriorly to  be  attached  to  the  united  extremities. 

Posterior  Pelvic  Triangle. — Similar  to  the  above  except 
it  is  applied  posteriorly  and  fastened  in  front. 

Scrotal  Hammock  (Figs.  114  and  -115). — This  dressing 
is  made  of  flannel,  16  inches  long  and  8  inches  wide,  from  the 
ends  of  which  a  V-shaped  wedge  is  cut,  4  inches  deep.  But- 
ton-holes are  cut  in  each  corner.  A  belt  of  webbing  or  flan- 
nel, with  a  button  sewed  on  it  over  each  anterior  superior 
spine,  is  fastened  around  the  waist.  Draw  one  edge  of  the 


MISCELLANEOUS  BANDAGES 


77 


FIG.  114. —  Scrotal  hammock. 


FIG.  115. — Scrotal  hammock. 


PRACTICAL  BANDAGING 


dressing  up  snugly  back  of  the  scrotum  and  button  the  two 
corners.  Bring  the  other  ends  up,  enveloping  the  scrotum, 
and  button  to  the  belt.  A  hole  may  be  cut  in  the  anterior 
fold  for  urination  if  so  desired. 

Scrotal  Triangle. — Tie  a  cravat  around  the  pelvis.  Place 
a  small  triangle  with  its  base  at  the  perineoscrotal  junction  and 

carry  one  extremity  up  each  side  of 
the  scrotum  to  pass  under  the  cravat 
from  above  downward.  Bring  them 
around  their  own  outer  edge  and  tie. 
Bring  the  apex  up  over  the  genitalia 
around  the  cravat  from  below  up- 
ward and  pass  it  under  the  united 
extremities. 

Scrotal  Square — Tie  one  side  of 
a  square  around  the  base  of  the  geni- 
talia. After  twisting  the  other  two 
corners  two  or  three  times,  pass 
them  around  the  tied  corners  from 
above  downward  and  around  their 
own  outer  edge  to  be  tied  in  front. 
Gluteal  Triangle. — Place  the  base 
of  the  triangle  with  the  apex  up  just 
below  the  fold  of  the  buttock.  Pass 
the  extremities  around  the  thigh 
i,  knee  triangle;  b,  foot  and  return  to  tie.  Carry  the  apex  up 

triangle. 

to  be  looped  around  a  pelvic  cravat. 

Inguinal  Triangle. — Similar  to  the  gluteal  triangle  but 
placed  over  the  groin. 

Tibiocervical  Sling. — Pass  a  long  cravat  over  the  shoulder 
of  the  sound  side  and  knot  it  at  the  waist  of  the  injured  side. 
Loop  a  triangle  around  the  leg,  with  the  base  toward  the 
ankle,  and  tie  the  extremities  through  the  cravat.  Fold  the 
apex  around  the  knees  and  pin. 


FIG.  116.- 


MISCELLANEOUS  BANDAGES  79 

Knee  Triangle  (Fig.  116). — With  the  base  above  the 
patella  and  apex  hanging  down  anteriorly,  pass  the  extremi- 
ties around  the  limb,  cross,  and  return  below  the  patella, 
tying  them  over  the  apex.  Turn  the  apex  up  and  pin  it. 

Foot  Triangle  (Fig.  116). — With  the  centre  of  the  base 
of  the  triangle  back  of  the  ankle,  the  apex  is  carried  under 
the  sole,  over  the  to€S  and  instep  to  front  of  ankle.  The 
extremities  encircle  the  ankle,  confining  the  apex  beneath 
them. 

Cravats. — The  application  of  cravats  is  so  very  simple 
that  it  is  not  deemed  necessary  to  explain  in  detail.  The 
bandage  is  a  very  useful  one  to  retain  temporary  dressings, 
in  emergency  or  first  aid  work  and  sometimes  as  a  temporary 
tourniquet.  It  is  applied  in  the  desired  position,  wrapped 
around  the  part,  and  the  ends  pinned  or  tied  together.  Its 
commonest  use  is  as  a  wrist  sling.  The  centre  of  the  body 
of  the  cravat  is  looped  under  the  wrist  and  the  two  ends 
carried  one  around  each  side  of  the  neck  and  tied  together, 
preferably  in  front.  It  is  sometimes  used  to  sling  the  lower 
extremity  around  the  waist  or  neck. 

When  used  as  a  tourniquet  it  is  passed  around  the  part 
between  the  heart  and  the  wound,  and  its  ends  tied  together 
so  that  the  cravat  is  loose  enough  to  allow  of  the  introduction 
and  the  twisting  of  a  lever  in  the  shape  of  the  hand,  or  a 
stick  of  some  sort. 


PART  III 

ELASTIC  BANDAGES 

There  are  three  types  of  rubber  bandages  (Figs.  117  a,  b 
and  c)  :  (i)  Martin's  bandage,  (2)  elastic  webbing  band- 
a£e>  (3)  Esmarch  tourniquet,  and  (4)  Unna's  dressing. 

Martin's  Rubber  Bandage. — This  is  a  strip  of  rubber 
varying  in  width  from  2  to  4  inches  and  in  length  from  3  to 


FIG.  1170. — Rubber  bandage. 


FIG.  1176. — Elastic  fabric  bandage. 


FIG.  inc. — Esmarch  tourniquet. 

5  yards.  It  has  attached  to  one  end  two  tapes  by  which  the 
bandage  is  secured.  In  applying  the  bandage,  no  reverses  are 
used  and  very  little  tension  is  applied.  It  is  preferable  to 
have  a  gauze  or  flannel  bandage  or  stockinette  next  the  skin 
to  absorb  the  moisture.  The  dressing  should  be  kept  free  from 
all  ointments,  oils,  ether,  etc.,  which  are  harmful  to  rubber. 
80 


ELASTIC  BANDAGES  gz 

It  should  be  removed  at  least  once  in  24  hours  to  allow  it  to 
dry  out.  It  is  applied  without  reverses. 

Elastic  Webbing. — This  is  an  improvement  over,  and  has 
none  of  the  disagreeable  features  of  the  Martin  bandage.  It 
is  made  of  a  rubber  or  elastic  network  covered  with  a  fabric 
of  cotton  or  silk.  It  is  used  in  the  same  way  as  the  Martin 
bandage,  except  that  it  demands  no  gauze  or  flannel  next  the 
skin.  It  possesses  the  distinct  advantage  of  permitting 
evaporation  of  perspiration.  No  reverses  are  used  in  its 
application. 

Esmarch  Tube  or  Tourniquet. — This  is  a  rubber  strap 
about  i  to  1 1/4  inches  wide,  l/%  inch  thick  and  5  to  6  feet  long, 
with  a  hook  on  one  end  and  a  chain  on  the  other.  Its  chief 
use  is  as  a  means  of  preventing  hemorrhage  from  wounds  in 
the  extremities.  It  is  not  properly  a  bandage.  When  applied 
as  a  tourniquet,  the  part  should  be  elevated  for  10  minutes 
before  application.  With  a  turn  or  two  of  bandage  beneath 
it,  apply  the  tourniquet  on  a  stretch  until  the  pulse  disappears 
below  it.  Have  the  turns  overlap  each  other  and  hook  the 
ends. 

Elastic  Fabric  Bandage. — This  elastic  bandage  is  made 
entirely  of  cotton  woven  in  a  manner  to  allow  stretching 
almost  equal  to  that  of.  rubber.  It  possesses  all  the  advantages 
and  qualities  of  a  bandage  interwoven  with  rubber,  yet  is 
lighter,  more  durable,  permits  evaporation,  may  be  washed 
repeatedly,  and  has  no  odor.  It  is  readily  sterilized  and  can 
be  kept  indefinitely.  In  its  application  reverses  are  un- 
necessary. 

Unna's  Dressing. — This  dressing  is  composed  of  layers 
of  gauze  bandage  soaked  with  a  paste  (Unna)  composed  of 
gelatine,  1 5  parts ;  glycerin,  1 5  parts ;  zinc  oxide,  30  parts ;  and 
water,  40  parts.  This  paste  when  cold  has  a  gummy  elasticity, 
but  when  heated  over  a  water  bath,  it  becomes  liquid.  Appli- 
cation: Heat  the  Unna  paste  over  a  water  bath  until  it  is 
6 


32  PRACTICAL  BANDAGING 

liquid  but  not  hot  enough  to  burn  the  skin.  Paint  it  with 
a  brush  on  the  skin  of  the  part  to  be  dressed.  Cover  with  a 
layer  of  gauze  bandage.  Repeated  alternate  layers  of  gauze 
and  paste  to  the  number  of  three  or  four  complete  the  dress- 
ing. The  dressing  is  allowed  to  dry  out  and  is  then  covered 
with  a  dry  gauze  bandage,  dusted  with  talc  or  varnished. 

If  desirable,  fenestra  may  be  cut  in  the  dressing  to  permit 
of  attention  to  underlying  conditions. 

The  Unna  dressing  makes  an  excellent  substitute  for 
rubber  bandages  used  as  support  to  the  lower  leg,  as  in 
varicose  conditions.  It  gives  excellent  support,  is  cheap, 
allows  of  care  of  ulceration  through  opening  in  it,  may  be  left 
on  from  days  to  weeks  in  some  cases  and  also  seems  to  have 
some  medicinal  effect  on  the  eczematous  condition  which  so 
often  exists.  Drugs  such  as  resorcin,  boric  acid  and  carbolic 
acid  in  small  proportions  are  sometimes  added. 


PART  IV 

ADHESIVE  DRESSINGS 

ADHESIVE  plaster  dressings  are  used  chiefly  for  support, 
fixation  and  compression  in  sprains,  fractures  and  chronic 
exudative  conditions  in  tendons,  bursse,  etc. 

Surgeon's  Adhesive  Plaster. — This  is  the  original  rubber 
adhesive  of  a  deep  yellow  color,  made  with  caoutchouc  as  a 
base.  It  is  adhesive  at  all  degrees  of  atmospheric  tempera- 
ture, retains  its  adhesiveness  a  long  time  and  is  not  affected 
by  moisture  in  the  atmosphere.  When  necessary  to  keep  it 
for  a  length  of  time  it  is  best  preserved  in  tin- foil,  paper  or 
box. 

"  ZO  "  Adhesive  Plaster. — This  plaster  is  an  improve- 
ment over  the  surgeon's  adhesive  in  that  it  is  made  from 
rubber  from  which  the  irritating  substances  have  been  re- 
moved. It  is  preferable  to  the  surgeon's  plaster  because  it  is 
less  irritating,  neater  and  cleaner  looking,  and  in  addition  is 
put  up  in  sterile  packets.  Moreover,  it  never  leaves  its  ad- 
hesive material  on  the  skin  as  sometimes  occurs  with  the 
surgeon's  rubber  plaster. 

Janus  Adhesive  Plaster. — This  plaster  has  one  surface 
coated  with  "  ZO  "  and  the  other  with  plain  adhesive.  It  is 
sometimes  used  for  fixing  a  dressing  to  the  skin. 

De  La  Cour's  Adhesive  Plaster. — The  plaster  is  made  of 
lead,  resin,  and  wax  and  is  most  often  designated  by  the  term 
"  resin  plaster."  The  plaster  has  its  surface  protected  with 
tissue  paper.  When  cool  the  paper  strips  off  readily,  but  ad- 
heres tightly  when  warm.  Hence  this  adhesive  plaster  is 
usually  kept  near  ice  in  warm  weather.  A  very  convenient 
manner  of  keeping  a  ready  supply  is  to  tear  off  the  paper,  cut 
the  strips  the  desired  lengths,  and  fold  up  in  oiled  paper. 

83 


84  PRACTICAL  BANDAGING 

The  strips  should  always  be  cut,  never  torn.  Before  applying 
a  strip,  it  must  be  heated.  This  may  be  done  by  laying  it  on 
the  sterilizer  or  autoclave  or  by  passing  it  over  a  flame,  ad- 
hesive surface  down,  until  the  light  yellow  color  of  the  back- 
ing changes  to  a  deeper  yellow.  It  is  very  important  that  the 
ends  of  the  strips  be  well  warmed  (Fig.  118). 

Various  weight  materials  are  used  as  backing  for  the 
adhesive,  the  heaviest  being  mole  skin.  This  mole  skin  ad- 
hesive is  used  for  the  making, of  extension  dressings,  sup- 
portive belts,  etc. 


FIG.  1 1 8. — Heating  adhesive  plaster. 

Isinglass  Plaster. — This  plaster  is  a  gelatine  adhesive 
plaster,  spread  on  different  weight  backings.  It  is  to-day 
manufactured  under  sterile  precautions.  It  needs  wetting 
before  applying  and  if  it  is  applied  near  an  open  wound  it 
should  be  moistened  with  an  antiseptic  solution.  Court- 
plaster  is  merely  isinglass  spread  on  various  colored  cloths. 

General  Considerations:  "  ZO  "  and  rubber  adhesive  are 
applied  at  room  temperature  although  a  little  warmth  in- 
creases their  adhesive  qualities.  When  tearing  the  adhesive 


ADHESIVE  DRESSINGS  85 

roll  into  strips  it  is  better  to  first  separate  the  backing  of  web- 
bing for  half  an  inch  or  so  across  the  entire  width  of  the  roll. 
In  starting  the  webbing,  be  careful  not  to  allow  the  extreme 
corner  of  the  adhesive  to  fold  upon  its  adhesive  surface  and 
adhere,  causing  the  ends  to  curl  up  after  application.  Should 
this  occur  it  is  best  to  cut  the  end  off  rather  than  separate  it. 
With  a  pair  of  scissors,  make  cuts  along  the  freed  edge, 
distant  from  each  other  the  width  of  the  strip  desired,  and 
tear  down  the  required  length.  Never  attempt  to  tear  ad- 
hesive plaster  across  its  width  but  always  in  the  direction 
of  its  long  threads. 

Before  attempting  to  apply  adhesive  the  operator  should 
remove  his  gloves  and  free  his  hands  of  powder  or  moisture. 
The  part  to  be  dressed  must  be  shaved  and  freed  from  all 
soap  and  moisture  by  the  application  of  alcohol,  ether  or 
benzine.  In  the  application  of  the  adhesive  strips  care  must 
be  taken  that  the  skin  is  not  folded  or  creased  between  the 
strips,  as  this  causes  discomfort  and  destruction  of  the  epi- 
dermis resulting  in  ulceration.  When  convenient  the  ad- 
hesive dressing  should  be  covered  with  a  snug  gauze  bandage, 
which  causes  the  adhesive  to  adhere  more  firmly,  as  well  as 
giving  additional  support. 

The  manner  of  the  removal  of  adhesive  from  the  skin  is 
very  important.  If  it  is  to  be  removed  dry,  free  the  ends 
and  draw  it  slowly  back  upon  itself,  gently  pressing  the  skin 
down  away  from  the  adhesive  surface  (Fig.  119).  This 
method  causes  little  discomfort.  Another  dry  and  more 
rapid  method  is  to  free  an  end  and  then  with  a  quick  jerk 
remove  the  plaster.  This  sometimes  carries  the  outer  layer 
of  the  skin  with  it. 

For  removal  with  the  help  of  solutions,  ether,  alcohol, 
benzine,  gasoline  and  turpentine  may  be  used.  The  best 
result  is  obtained,  if  end  of  adhesive  strip  is  turned  up  and 
the  solution  applied  to  its  under  surface  with  cotton  or  gauze. 


86 


PRACTICAL  BANDAGING 


Adhesive  once  removed  from  the  skin  after  being  in 
place  more  than  a  few  moments,  can  never  be  used  again 
with  any  degree  of  satisfaction,  since  it  fails  to  stick  tightly. 
Resin  plaster  will  adhere  again  if  reheated. 

When  the  adhesive  is  left  on  for  some  days,  it  causes 
a  dermatitis  which  is  characterized  by  the  formation  of 
pustules  and  an  itching  sensation.  This  is  minimal  under 
resin  plaster  or  "  ZO  "  perforated  sheets.  Delicate  skin, 
especially  that  of  an  infant  in  warm  weather,  does  not  tolerate 
adhesive  plaster  for  any  length  of  time. 


FIG.  1 19. — Removing  adhesive  strips. 


Abdomen  (Figs.  120  a,  b,  c  and  d). — Adhesive  plaster, 
"  ZO,"  on  mole  skin  preferably,  7  inches  wide  and  long 
enough  to  a  little  more  than  encircle  the  patient's  waist.  The 
plaster  is  folded  lengthwise  with  ends  meeting  and  cut  in  a 
curved  line  from  Iqwer  corner  of  the  fold  to  an  inch  of  the 
upper  corner  of  the  two  ends.  This  gives  3  pieces,  I,  2,  3. 
The  patient  should  be  in  the  dorsal  position  with  the  hips 
slightly  elevated,  when  the  plaster  is  applied.  No.  i  piece  is 
applied  with  its  long  straight  side  passing  around  the  wrist 


ADHESIVE  DRESSINGS 


in  a  slightly  upward  direction,  just  catching  the  lower  ribs. 
A  V-shaped  notch  is  cut  to  expose  the  umbilicus  and  the 
lower  point  is  cut  off  to  avoid  adhesion  with  the  pubic  hair. 
The  pieces  2  and  3  are  applied  over  i,  one  on  each  side  with 


FIG.  1200. — Rose  binder  pattern. 


FIG.  1206. — Rose  binder  being  applied. 

the  curved  edge  looking  upward  and  inward  to  adhere  to  the 
lower  ribs.     It  is  designated  as  "  the  Rose  binder." 

Umbilicus — Indication,  umbilical  hernia,  small  and  re- 
ducible. Prepare  two  strips  of  zinc  oxide  or  resin  adhesive 
plaster  il/2  inches  in  width,  one  strip  being  long  enough 
to  encircle  the  abdomen  two-thirds  way,  the  other,  two  to 


88 


PRACTICAL  BANDAGING 


three  inches  long.  Place  an  umbilical  button,  a  coin  or  a 
circle  of  gauze,  J4  incn  thick  and  of  sufficient  size  to  easily 
cover  the  umbilicus,  on  the  centre  of  the  long  strip.  Place 
the  centre  of  the  short  strip  over  this,  with  its  adhesive  sur- 
face facing  the  adhesive  surface  of  the  long  piece.  With  the 
abdomen  relaxed,  accomplished  best  by  elevation  of  pelvis, 
with  the  hernia  reduced  apply  the  button  over  the  orifice. 


FIG.  120  c. — Rose  binder  (posterior  view).        PIG.  120  d. — Rose  binder  (anterior  view). 

Draw  the  abdominal  skin  forward  and  carry  the  ends  of 
the  strap  backward  and  slightly  upward,  applying  them 
snugly. 

Shoulder  (Sayre  Dressing). — Prepare  two  strips  of  ad- 
hesive plaster  two  or  three  inches  wide,  long  enough  to  en- 
compass the  chest  one  and  a  half  times.  A  collar  of  gauze 
or  line  a  shade  wider  than  the  adhesive  strip  is  placed  around 
the  arm  of  the  affected  side.  Looping  one  end  of  one  of  the 


ADHESIVE  DRESSINGS 


89 


strips  around  the  collar,  with  the  adhesive  side  toward  the 
chest,  drawing  the  arm  backward,  the  other  end  is  carried 
straight  across  the  back  and  around  the  chest.  Draw  the 
elbow  forward  and  place  the  hand  of  the  affected  side  on 
the  opposite  shoulder.  Having  cut  a  hole  in  the  centre  of 
the  second  strip  for  the  elbow,  place  this  hole  over  the 
elbow.  Then  standing  on  the  opposite  side  of  the  patient, 


PIG.  121. — Say  re  dressing  modified. 

draw  the  two  extremities  taut  in  the  line  of  the  forearm. 
Carry  the  posterior  extremity  diagonally  across  the  back  and 
around  the  opposite  shoulder,  the  anterior  strip  up  the  fore- 
arm and  over  opposite  shoulder.  This,  the  original  Sayre 
dressing,  has  the  disadvantages  of  a  low  placed  imprisoned 
hand,  which  becomes  very  uncomfortable  due  to  pressure 
on  the  knuckles  and  fingers. 

Sayre  Modified  (Fig   121). — Dressings,  the  same  as  the 


g0  PRACTICAL  BANDAGING 

Sayre  except  the  anterior  strap  passing  from  the  affected 
elbow  to  the  opposite  shoulder  has  slits  cut  to  enable  the 
fingers  to  come  through.  A  small  gauze  pad  is  placed  on  the 
dorsum  of  the  hand  and  two  or  three  thicknesses  of  gauze 
between  the  forearm  and  chest.  With  the  hand  of  the  af- 
fected side  placed  well  up  over  the  opposite  clavicle  the  ad- 
hesive strap  is  applied  as  seen  in  Fig.  121. 


FIG.  122. — Acromioclavicular  support. 

Acromioclavicular  Joint  (Fig.  122). — Cut  an  adhesive 
strip  two  inches  wide  and  five  feet  long.  Fashion  a  pad  of 
14  to  1 6  thicknesses  of  gauze  2  inches  square  with  a.  hole  cut 
in  its  centre.  With  the  arm  of  the  affected  shoulder  beside 
the  chest  and  the  forearm  flexed  at  right  angles,  loop  the 
centre  of  the  adhesive  strip  under  the  elbow  about  I  inch  from 
the  tip.  Place  the  pad  over  the  outer  end  of  the  collar  bone 
and  while  an  assistant  presses  down  on  the  pad  and  up  on 
the  elbow,  cross  the  two  ends  of  the  adhesive  over  the  pad. 


ADHESIVE  DRESSINGS 


i 


p2  PRACTICAL  BANDAGING 

carrying  one  end  down  across  the  chest  and  the  other  end 
down  across  the  back.  Apply  a  cravat  sling  at  the  wrist. 
The  dressing  is  used  chiefly  in  dislocation  of  the  outer  end 
of  the  collar  bone  or  clavicle. 

Taped  Adhesive  (Montgomery  Strap)  (Fig.  123,  a). — Al- 
though two  or  more  straps  are  employed,  being  all  alike,  the 
description  of  one  will  suffice.  A  strip  of  adhesive  the  de- 
sired length  and  width,  depending  on  its  use,  has  attached  to 
one  end  a  narrow  tape  from  3  to  6  inches  long.  The  tape  can 
be  attached  by  stitching  or  by  passing  it  through  a  hole  near 
the  end  of  the  adhesive  and  knotting  before  folding  over  the 
adhesive,  as  seen  in  illustration.  The  last  two  inches  of  the 
tape  end  has  its  adhesive  surface  covered  by  an  adhesive  strip 
applied  with  the  fabric  side  out.  This  prevents  adhering  to 
the  dressings.  These  straps  are  useful  to  retain  dressings 
that  need  frequent  changing.  They  are  applied  in  pairs  op- 
posite each  other  and  tapes  tied  over  the  dressing.  To  change 
the  dressing,  untie  the  tapes  and  turn  back  on  either  side. 

Catheter  Straps  (Fig.  123,  b) . — This  type  strap  is  made 
as  the  above,  differing  only  in  having  the  tape  replaced  by 
heavy  silk  thread.  The  adhesive  straps  are  cut  */2  inch  wide 
and  2^/2  inches  long.  Two  to  four  are  usually  employed. 
Place  longitudinally  along  the  shaft  of  the  penis  and  hold 
in  place  by  a  spiral  bandage. 

Dumb-bell  Adhesive  Strap  (Fig.  123,  c) . — With  the  web- 
bing loosened  at  one  extremity  fold  the  adhesive  plaster  back 
upon  itself.  Cut  out  in  the  shape  of  one  end  of  a  dumb- 
bell, the  centre  of  the  bar  corresponding  to  the  folded  edge  of 
the  plaster.  When  unfolded  this  forms  a  symmetrical  dumb- 
bell or  double-bladed  canoe  paddle  dressing.  Strip  off  the 
webbing  and  apply  as  desired.  Its  common  use  is  as  a  tension 
strap  for  repaired  hair  lips  and  other  wounds  whose  edges 
are  inclined  to  separate. 

Laced  Adhesive  (Fig.  123,  d). — To  one  edge  of  two  ad- 
hesive strips  the  desired  length  and  width,  are  sewed  small 


ADHESIVE  DRESSINGS 


93 


dress  hooks,  opposite  each  other.  The  two  straps  are  applied 
one  on  each  side  of  the  wound,  with  the  hooks  next  the 
wound,  and  laced  together  with  a  silk  thread. 

Splints  (Fig.  123,  e). — Adhesive  plaster  is  often  used  to 
splint  a  broken  finger  by  binding  the  injured  member  to  the 
neighboring  finger,  or  by  reduplicated  strips.  Coaptation 


FIG.  124. — Back  strapping. 

splints  are  frequently  united  in  series  by  placing  them 
parallel  between  two  sheets  or  wide  strips  of  adhesive,  thus 
forming  a  Gooch  splint  (see  figure). 

Furuncle  Cone  (Fig.  123,  /). — Cut  a  circle  of  adhesive 
the  desired  size.  Make  an  incision  from  the  circumference  to 
its  centre  and  overlapping  make  a  dart.  If  desired  the  apex 
of  the  cone  may  be  cut  off  to  permit  evaporation. 

Back  (Fig.  124). — Fifteen  or  twenty  "  ZO  "  adhesive 
strips  I  inch  wide  and  from  10  to  12  inches  long  are  re- 


94 


PRACTICAL  BANDAGING 


quired.  Apply  the  first  strip  reaching  from  just  below  the 
angle  of  the  shoulder-blade  on  one  side  to  the  posterior 
superior  spine  of  the  iliac  bone  of  the  opposite  side.  Cross 
this  strip  with  a  similar  one  passing  from  the  other  shoulder- 
blade  to  the  opposite  posterior  iliac  spine.  Apply  these  strips 
alternately,  crossing  them  in  the  midline  of  the  back  and 
proceeding  down  the  back,  each  strip  overlapping  one-half 


FIG.  125. — Buck's  extension. 

the  width  of  the  corresponding  one  immediately  preceding. 
Stirrup  Extension  Strap  (Buck's  Extension)  (Fig.  125). 
— Fold  a  long  piece  of  mole  skin  adhesive  upon  itself  for  the 
desired  length  of  the  extension.  For  example,  it  should 
measure  6  or  8  inches  longer  than  the  distance  from  its 
highest  point  of  application  to  the  foot,  in  case  of  a  lower 
extremity  dressing.  With  the  loop  edge  the  centre  of  the 
handle,  cut  the  doubled  material  in  the  shape  of  one  end  of 
a  double-bladed  canoe  paddle,  the  blade  being  lengthened 


ADHESIVE  DRESSINGS 


95 


toward  the  handle.  The  blades  should  be  a  little  less  than 
one-half  the  circumference  of  the  part  it  is  to  cover  and  the 
handle  should  be  2^  to  3  inches  wide.  Cut  a  small  hole  in 
the  centre  of  the  handle  and  place  over  the  hole  the  centre 
of  the  stirrup  or  spreader,  a  piece  of  wood,  the  width  of  the 
strap,  a  little  longer  than  width  of  part  where  the  adhesive 
leaves  it,  and  y±  inch  thick.  Cover  exposed  sides  of  spreader 
and  for  6  to  8  inches  out  on  adhesive  side  of  strap  with  a 


FlG.  126. — Ankle  strapping. 

strip  of  adhesive  of  same  width  and  with  hole  in  centre.     A 
stout  cord  passes  through  the  superimposed  holes. 

Ankle  (Fig.  126).— Take  about  10  strips  of  "  ZO,"  10 
inches  long  and  J4  to  %  mcn  wide,  and  10  strips  of  the 
same  width,  but  from  14  inches  to  16  inches  long,  shave  off 
any  hair  that  may  be  present.  Place  the  foot  at  right  angles 
to  the  leg.  A  long  strip  is  applied  with  the  centre  over  the 
back  part  of  the  sole  of  the  heel  and  the  two  ends  carried  up 
one  on  each  side  of  the  Achilles  tendon,  putting  the  most 


95  PRACTICAL  BANDAGING 

tension  on  the  end  corresponding  to  the  side  of  the  strained 
ligament.  A  short  strip  is  next  applied  to  the  posterior  aspect 
of  the  heel  as  low  down  as  possible  and  each  end  is  applied  on 
one  side  of  the  foot  as  near  the  plantar  surface  as  possible. 
The  strapping  is  continued  by  alternating  first  a  long  strip 
up  the  leg,  then  a  shorter  strip  down  the  foot.  Each  strip 
overlaps  about  one-half  the  width  of  the  previous  one.  The 
leg  strips  approach  the  front  of  the  leg  and  the  foot  strips 
ascend  the  foot.  Extending  up  the  middle  of  the  dorsum  of 
the  foot  and  ankle  there  should  be  a  space  at  least  three- 
quarters  of  an  inch  wide  left  free  of  plaster,  in  order  to 
obviate  any  possibility  of  interference  with  the  circulation. 
Occasionally  a  few  circular  strips  are  applied  around  the 
instep  for  additional  support.  Cover  the  entire  dressing  with 
a  few  turns  of  gauze  bandage  to  retain  it  for  a  few  hours 
until  the  plaster  adheres. 

Another  method  of  strapping  the  ankle  is  by  using  six 
or  eight  pieces  of  adhesive  I  inch  wide  and  18  inches  long. 
To  fix  the  internal  ligament,  start  the  first  piece  on  the  dorsum 
of  the  foot;  pass  outward  around  the  outer  edge,  beneath  the 
instep,  up  the  inner  side  diagonally,  and  up  the  ankle  an- 
teriorly, crossing  to  the  outer  side  of  the  calf.  Apply  all 
the  strips  in  the  same  manner,  each  overlapping  about  one- 
half  the  previous  one.  To  splint  the  external  ligament,  re- 
verse the  direction  of  the  strips,  starting  on  the  outer  side  of 
the  foot  then  around  under  the  instep  and  up  the  inner  side  of 
the  leg.  These  dressings  are  used  very  often  as  supportive 
measures  in  the  treatment  of  sprains  of  the  ankle  and  tarsus. 

Chest  (Fig.  127). — For  fractured  ribs  have  six  or  eight 
adhesive  "  ZO  "  strips,  3  inches  wide  and  long  enough  to 
reach  from  the  spine  to  the  sternum.  Have  the  patient  stand 
or  lie  with  the  affected  side  toward  the  surgeon  and  with  the 
hand  of  the  same  side  on  his  head.  The  other  shoulder  should 
be  against  the  wall  or  something  solid,  if  patient  is  in  stand- 
ing position.  Apply  the  end  of  the  strip  firmly  at  the  spinal 


ADHESIVE  DRESSINGS  97 

column  at  least  3  or  4  inches  above  the  site  of  the  injury. 
The  patient  is  told  to  empty  the  lungs  and  as  he  does  so,  the 
plaster  strip  is  drawn  forcibly  downward  and  forward  and 
smoothly  applied  to  the  chest,  in  a  nearly  horizontal  direction. 
Each  strip  is  applied  in  this  manner,  overlapping  one-half 


FIG.  127. — Chest  strapping. 

the  previous  one.  The  dressing  should  extend,  if  possible, 
3  inches  or  4  inches  above  and  below  the  injured  rib  or  ribs. 
It  is  claimed  by  some  that  it  is  better  to  apply  the  strips  below 
first,  overlapping  from  below  upward.  The  dressing  properly 
applied  will  make  the  patient  comfortable,  relieving  him  of 
the  knife-like  pain  on  respiration.  If  this  is  not  accomplished 
the  dressing  must  be  applied  tighter.  For  pleurisy  the  dress- 
7 


98 


PRACTICAL  BANDAGING 


ing  should  cover  as  much  of  the  side  as  possible.  In  case  of 
the  upper  ribs  being  broken,  and  in  women,  better  fixation  is 
obtained  by  passing  a  strip  3  inches  to  4  inches  wide  entirely 
around  the  chest,  above  the  breasts. 

Should  additional  rigidity  and  fixation  be  desired,  suc- 
cessive layers  of  strips  may  be 
applied  crossing  each  other  in 
different  directions. 

Knee  (Fig.  128).— Have 
prepared  15  to  30  strips,  ^4  mcn 
wide  and  12  inches  to  14  inches 
long.  The  leg  is  extended  on  the 
thigh  and  the  hair  shaved.  A 
strip  is  applied  with  one  end  on 
the  outer  side  of  the  thigh  6 
inches  to  7  inches  above  the 
joint,  and  carried  diagonally 
down  across  the  knee  below  the 
joint  line,  and  on  the  inner  aspect 
of  the  leg.  The  second  strip  is 
started  on  the  inner  aspect  of  the 
thigh,  6  inches  or  7  inches  above 
the  joint,  and  then  carried 
diagonally  down  and  across  the 
joint,  crossing  the  last  strip  in  the 
midline  below  the  patella  and 
then  passing  on  down  on  the 
outer  aspect  of  the  leg.  The 
remaining  strips  are  applied  al- 

.      FIG.  128. — Knee  strapping.  J    .  1-1  j 

ternately  on  each  side,  and  over- 
lapping one-half  the  width  as  they  ascend  the  limb. 

Leg — Adhesive  strips,  J/£  inch  wide  and  long  enough  to 
three-quarters  encircle  the  leg,  are  torn.  Number  varies  with 
desired  size  of  dressing.  Apply  strips  as  described  in  strap- 
ping knee.  The  dressing  is  used  for  varicose  leg  ulcers. 


ADHESIVE  DRESSINGS  99 

Inguinal  Dressing  (Fig.  129). — This  is  made  of  a  piece 
of  flannel  6  inches  wide  and  16  inches  long  to  each  end  of 
which  is  sewed  a  strip  of  adhesive  plaster  16  inches  long. 
The  flannel  part  surrounds  the  leg,  the  adhesive  pieces  cross 
over  the  inguinal  region,  and  adhere  to  the  flanks. 

Achilles  Tendon  (Fig.  130). — The  foot  is  put  at  right 
angles  to  the  leg  or  in  position  of  a  slight  toe  point.  An  ad- 
hesive strap  1 8  inches  long  and  2  inches  wide  is  split  at  one 


PIG.  129. — Inguinal  dressing. 

end  for  two-thirds  of  its  length.  The  uncut  portion  of  the 
plaster  is  applied  to  the  sole  of  the  foot,  the  angle  of  the 
slit  reaching  the  point  of  the  heel.  The  outer  strip  is  now 
crossed  over  the  tendon  diagonally  to  the  inner  side  and 
carried  up  the  calf.  The  inner  strip  is  crossed  over  the  tendon 
diagonally  to  the  outer  side  and  carried  up  the  outer  side  of 
the  calf.  A  circular  strip  may  be  placed  around  the  ex- 
tremities of  the  strips  above  and  below.  The  dressing  is 


100 


PRACTICAL  BANDAGING 


often  better  made  with  several  strips  of  the  above  length  and 
YZ  inch  wide  applied  in  much  the  same  manner,  except  that 
they  are  started  under  the  instep,  passed  up  beside  the 

heel  and  across  the  tendon  up  the 
calf.  The  dressing  is  employed 
for  strains  of  the  tendon,  tenosyno- 
vitis,  and  rupture  of  the  tendon  or 
muscle. 

The  Testicles — First  remove 
the  hair  from  the  part  of  the  scro- 
tum to  receive  the  adhesive.  Then 
cut  1 5  to  20  adhesive  strips  5  inches 
long  and  l/4  inch  wide.  The  af- 
fected testicle  is  pushed  down  into 
the  scrotum,  the  scrotum  drawn 
tense  over  it  by  encircling  the  top 
of  the  testicle  with  forefinger  and 
thumb.  This  accomplished,  apply 
adhesive  strip  around  the  upper 
part  of  the  testicle.  Now  pass  the 
other  strips  around  the  testicle  in 
the  direction  of  its  long  axis,  be- 
ginning and  ending  on  the  circular 
strip  and  overlapping  a  third  of  the 
previous  strips.  When  covered  by 
a  layer  in  this  direction,  pass 
another  layer  at  right  angles  to  the 
first. 

Adhesive  Suspensory. — A  strip 
of  adhesive  5  inches  wide  and  12 
inches  long  is  split  down  the  middle 
for  two-thirds  its  length.  The 
penis  and  scrotum  are  pulled  up  on  the  abdomen  and  the 
broad  end  of  the  adhesive  applied  firmly  across  the  perineo- 
scrotal  junction.  The  split  in  the  plaster  is  lengthened  down 


PIG.  130. — Achilles  tendon 
strapping. 


ADHESIVE  DRESSINGS 


101 


to  the  penoscrotal  junction.  The  penis  is  drawn  into  the  apex 
and  the  two  ends  fastened  to  the  abdomen. 

Pelvic  Binder  (Fig.  131). — Cut  adhesive  strip  3^  inches 
to  4  inches  in  width  and  long  enough  to  pass  one  and  a  half 
times  around  the  hips.  Face  the  centra  '.ihu'd,  pf  tHe^frip 
with  a  similar  though  shorter  strip,  so  that  the  adhesive  sur- 
faces are  together.  With  the  patient  lying  O6*»iq£?  |£|4fc&JGP' 
or  standing,  pass  the  binder  across  the  lower  abdomen  be- 
tween the  crests  of  the  iliac  bones.  After  placing  a  small 
"bunion  plaster"  pad  around  each  anterior  spine  of  the 


FlG.  131. — Pelvic  binder. 

pelvis,  draw  the  two  ends  of  the  binder  taut,  crossing  them 
over  the  sacrum  and  carrying  each  toward  the  opposite 
trochanter. 

Sometimes,  in  patients  with  pendulous  abdomens,  this  long 
strap  binder  is  not  feasible  as  it  is  rolled  up  by  the  abdomen 
pressing  down  on  it.  In  such  cases,  several  strips  2  inches 
to  3  inches  wide  and  reaching  from  anterior  superior  spine 
across  the  back  to  opposite  anterior  superior  spine  are  applied 
crossing  each  other  in  the  centre  in  a  diagonal  direction  to- 
ward the  opposite  trochanter. 


PART  V 

.RLASTERrQF;PARIS  OR  GYPSUM  BANDAGES 

.  m  'General  Coh&idelrations. — Plaster  dressings  are  used  for 
fb&tidij'oipaftfej  tfvj£r  an  extended  period  of  time.  Less  com- 
mon fixation  dressings  are  silicate  of  soda  and  starch  dress- 
ing. The  material  used  for  the  bandage  is  unwashed  crino- 
line. This  is  cut  in  strips  the  desired  width  and  the  mesh 
filled  with  fresh  plaster  of  Paris,  dry  and  free  from  lumps. 


FIG.  132. — Making  plaster  bandages. 

A  much  quicker  way  is  to  spread  the  entire  width  of  the 
crinoline  with  the  plaster,  and,  after  rolling  it,  cut  it  the  de- 
sired lengths  by  the  use  of  a  saw  and  mitre  box  (Fig.  132). 
The  plaster,  if  exposed  to  damp  air,  will  become  air  slaked 
and  then  the  cast  will  crumble  apart.  To  avoid  this  bake  in  an 
oven  all  plaster  that  has  been  in  stock  for  some  time.  Spread 
the  plaster  on  the  unrolled  bandage  after  which  the  bandage 
102 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

is  rolled  loosely  and  if  to  be  kept  for  any  length  of  time  is 
stored  in  air-tight  receptacles. 

Plaster  bandages  can  be  bought  already  prepared,  and 
put  up  in  air-tight  receptacles.  Most  such  bandages  are  rolled 
too  tightly,  to  wet  through  easily,  and  are  made  of  gauze 
which  is  not  as  good  as  crinoline. 

As  a  broad,  general  principal,  a  plaster  cast  should  extend 
beyond  the  joint  on  each  side  of  the  fracture.  They  are  ap- 
plicable for  practically  every  fracture  except  those  of  the 
head,  clavicle,  ribs  and  of  the  femur  in  infancy.  A  newly 
applied  cast  should  be  viewed  in  a  few  hours.  If  this  is  im- 
possible the  cast  should  always  be  split  while  yet  damp.  Al- 
ways advise  the  patient  to  report  if  there  is  any  undue  swell- 
ing, coldness,  discoloration,  numbness,  tingling  or  throbbing, 
any  one  of  which  may  indicate  that  the  dressing  is  too  tight. 
A  properly  applied  cast  should  be  comfortable.  Any  con- 
tinued complaint  on  the  part  of  the  patient  should  demand 
careful  examination  or  even  the  removal  of  the  cast. 

Application  of  a  Plaster  Cast — The  part  to*  be  dressed 
should  be  shaved  and  washed  and  then  covered  with  flannel 
bandages,  cotton,  tricot  hose,  or  sheet  wadding,  torn  in  band- 
age strips  and  applied  in  the  manner  of  a  bandage,  also  all 
bony  prominences  should  be  well  padded  with  some  soft 
material  (preferably  non- absorbent  cotton)  to  prevent  pres- 
sure points.  Have  ready  a  gown  for  the  doctor  and  protec- 
tion for  the  bed  and  floor.  Have  a  basin  or  bowl  with  suffi- 
cient warm  water  in  it  to  completely  cover  the  plaster  bandage 
when  set  on  end  in  the  bowl.  A  bowl  of  loose,  dry  plaster, 
some  table  salt,  and  some  vaseline  or  petrolatum  should  also 
be  handy.  A  pinch  of  the  salt  dissolved  in  the  water  will 
hasten  the  hardening  or  setting  of  the  plaster.  The  vaseline 
may  be  rubbed  into  the  operator's  hands  in  the  absence  of 
gloves  to  prevent  the  plaster  sticking  to  them  or  on  the 
patient's  skin  for  the  same  reason.  The  plaster  rollers  are 


104 


PRACTICAL  BANDAGING 


immersed  one  at  a  time  in  the  warm  water  as  needed  and 
allowed  to  remain  standing  on  end  until  the  air  bubbles  have 
ceased  to  rise  from  the  roller.  The  bandage  must  not  be 
submerged  until  the  operator  is  nearly  ready  for  it,  for  if 
allowed  to  remain  in  the  water  too  long  the  plaster  sets  and 
becomes  hard,  and  is  rendered  useless.  On  removing  the 
roller  from  the  water  both  ends  should  be  grasped  (Fig.  133) 


FIG.  133. — Method  of  squeezing  water  from  bandage. 

and  the  excess  water  squeezed  out  by  a  twisting  motion.  To 
obviate  loss  of  plaster  in  submerging,  .each  bandage  may  be 
wrapped  in  filter  paper  or  Japanese  paper  napkins.  With 
wrapper  still  on,  the  bandage  is  removed  from  the  water  and 
squeezed.  The  water  escapes  but  not  the  plaster.  The  part  to 
be  bandaged  is  held  by  an  assistant,  two,  if  necessary,  in  the 
exact  position  ultimately  desired.  In  applying  the  plaster 
bandage  the  principles  of  an  ordinary  bandage  are  used,  with 
few  exceptions.  The  plaster  bandage  is  never  pulled  taut; 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

nor  reverses  used  in  the  first  layer  or  two,  for  as  the  bandage 
does  not  slip,  the  change  in  direction  is  accomplished  by  the 
folding  of  a  dart  in  the  inferior  edge,  and  then  using  short 
figure-of-8  turns.  The  turns  should  overlap  about  one-half 
the  previous  turns  and  the  loose  borders  in  any  turn  are 
smoothed  back  with  the  thumb  and  finger  as  "  darts  "  which 
readily  adhere  and  stay  in  place.  An  excellent  finish  can  be 
given  the  dressing  by  turning  back  cuff-like  fashion,  the  ends 
of  the  flannel  bandage,  wadding,  or  tricot  used,  and  holding 
it  in  place  by  the  final  turns  of  the  plaster  bandage,  catching 
the  free  edge.  While  the  cast  is  still  pliable  it  may  be  molded 
to  fit  the  contour  of  the  part.  This  is  a  dangerous  procedure 
except  in  skilled  hands  as  pressure  points  are  likely  to  be 
produced. 

The  discarded  plaster  in  the  basin  should  not  be  poured 
down  the  waste,  as  it  will  harden  and  close  the  drain  pipe. 

In  order  to  reinforce  a  cast,  use  is  made  of  strips  of  box- 
wood, card-board,  gutta  percha,  tin  and  zinc,  bent  to  fit  the 
part,  and  covered  in  by  the  plaster  bandage  (Fig.  145,  a). 
At  times  the  reinforcement  is  made  by  simply  reduplicating 
several  turns  of  the  bandage  of  a  recurrent  nature,  each  ap- 
plied on  the  preceding  ones  and  smoothed  down.  To  give 
additional  support  and  strength,  a  cream  of  plaster  (gyp- 
sum), made  by  mixing  the  plaster  with  water,  is  applied  by 
the  hands  in  a  thin  layer  between  the  succeeding  turns.  The 
plaster  cream  is  mixed  as  follows :  The  desired  amount  of 
cold  water  is  placed  in  a  basin  and  dry  plaster  powder  is 
dusted  by  hand  into  the  water  until  the  solution  is  saturated, 
which  is  indicated  by  the  plaster  floating  on  the  water.  When 
this  point  is  reached  stir  with  the  hand  until  the  plaster  has  a 
creamy  consistency.  A  strong  objection  to  the  use  of  this 
cream  between  the  layers,  is  the  increased  weight  added  to  the 
cast,  and  at  the  same  time  rendering  it  more  brittle.  Finally, 
the  completed  cast  is  covered  with  this  gypsum  cream,  which 


I0<5  PRACTICAL  BANDAGING 

is  smoothed  off  with  a  wet  cloth.  This  when  dried  gives 
a  gloss  that  is  especially  desirable  in  cases  where  urine  is 
liable  to  come  in  contact  with  the  cast.  A  coating  or  varnish 
may  be  applied,  after  the  cast  has  thoroughly  dried.  Great 
care  must  be  exercised  during  the  application  and  afterward, 
until  setting  has  occurred,  that  the  limb  is  held  in  the  one 
position  desired,  and  that  the  cast  is  not  indented  by  fingers 
or  other  pressure.  After  10  to  20  minutes  when  the  cast 
has  begun  to  harden,  the  limb  may  be  rested  on  a  soft  pillow 
for  its  full  length.  Free  access  of  the  air  to  the  plaster  is 
necessary,  as  it  takes  from  20  to  24  hours  to  dry  out  thor- 
oughly. When  a  hot  air  apparatus  is  at  hand  the  cast  may  be 
baked  for  half  an  hour.  Immediately  after  the  completion 
of  the  bandage,  the  circulation  of  the  part  distal  to  the  band- 
age should  be  examined,  a  part  being  left  exposed  for  this 
purpose.  Should  the  cast  be  too  tight  as  shown  by  discolored, 
cold,  numb  or  tingling  extremities,  it  should  be  cut  through 
longitudinally,  while  still  moist,  and  any  underlying  con- 
stricting band  of  wadding  or  bandage  cut  through.  Follow 
this  with  elevation  of  the  part,  and  it  will  seldom  be  necessary 
to  remove  the  entire  cast 

Method  of  Removing  a  Plaster  Cast. — While  the  cast  is 
yet  moist  a  groove  is  cut  with  a  sharp  knife,  longitudinally, 
to  within  an  inch  of  each  end.  The  sensation  readily  im- 
parted to  the  hand  when  the  knife  cuts  through  upon  the 
flannel  bandage  or  wadding,  tells  one  when  the  cast  is  divided. 
A  Gigli  or  chain  saw  may  be  placed,  Fig.  134,  at  the  time 
of  application,  under  the  plaster  bandage  in  the  desired  posi- 
tion and  later  the  plaster  cut  by  a  sawing  motion  and  the 
sides  pulled  apart  as  in  Fig.  135.  An  additional  safeguard 
against  possible  injury  to  the  underlying  parts  is  the  applica- 
tion of  a  zinc  strip,  or  an  oiled  rubber  tubing  placed  under  the 
plaster  bandage,  in  the  line  of  incision,  its  ends  protruding  to 
indicate  where  to  cut.  A  similar  line  of  incision  on  the 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 


107 


I0g  PRACTICAL  BANDAGING 

opposite  side  of  the  cast  will  enable  one  to  remove  it  in  two 
longitudinal  sections.  Should  it  be  desired  to  cut  the  cast 
after  it  is  hardened,  mark  the  line  of  the  intended  cut  with 
the  knife,  then  apply  a  few  drops  of  water,  vinegar,  acetic 
acid  or  dilute  hydrochloric  acid  along  the  groove  and  proceed 
to  cut  through  the  cast,  using  more  fluid  from  time  to  time 
to  facilitate  the  cutting.  If  a  furrow  is  cut  from  a  cast  it  can 


FIG.  135. — Removal  of  cast. 

be  readily  sprung  off  and  on  again  if  desired.  In  removing 
a  cast  always  cut  through  the  under  dressing  and  remove  it 
with  the  cast,  as  it  always  adheres  to  the  plaster.  When  a 
cast  is  reapplied  its  edges  may  be  held  together  with  a  band- 
age or  adhesive  straps. 

Fenestration  of  Casts  (Fig.  136). — This  is  to  permit  the 
dressing  of  the  wounds  without  necessitating  removal  of  the 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

cast.  The  site  of  the  wound  should  be  accurately  determined 
by  measurement  before  the  part  is  bandaged.  The  gauze 
dressing  over  the  wound  should  be  the  size  and  shape  of  the 
desired  fenestra  or  window.  After  marking  out  on  the  still 
damp  plaster  the  outlines  of  the  opening,  the  window  is  cut 
out  with  a  sharp  knife,  just  as  in  removing  a  cast.  The  rough 
edges  of  the  cast  are  covered  with  radiating  strips  of  adhesive, 
shellac,  gutta  percha  tissue,  or  oiled  silk.  A  second  method 
of  fenestration  is  to  place  a  pill  box  top,  a  glass,  or  graduate 
over  the  wound  and  carry  the  turns  of  the  plaster  around 


FIG.  136. — Fenestration  of  cast. 

this.  A  third  method  is  to  cut  two  pieces  of  blotting  paper 
the  size  and  shape  of  the  desired  opening,  pass  a  pin  through 
the  centre  of  one  and  place  over  the  wound,  allowing  the 
pin  to  stick  up.  Apply  the  plaster  around  the  pin,  then  when 
ready  to  cut  out  the  window,  place  the  second  piece  of  blotter 
with  the  pin  through  its  centre,  and  cut  out  around  it. 

Ambulatory  Casts — This  manner  of  fracture  dressing  is 
applicable  to  fracture  of  the  leg  and  ankle  where  there  is  no 
need  for  extension,  or,  when  the  patient  must  be  around  even 
though  unable  to  use  two  crutches,  because  of  disability  of 
one  arm.  The  upper  limit  of  the  cast  should  be  above  the 
knee,  for  fractures  above  the  middle  of  the  leg,  and  only  up 


no 


PRACTICAL  BANDAGING 


to  the  tibial  tuberosities  in  lower  fractures.  The  cast  must 
be  especially  heavy  at  the  knee  and  ankle  and  the  sole  of  the 
foot,  to  prevent  cracking  from  weight.  It  transfers  the 
weight  from  the  tuberosities  of  the  tibia  to  the  ground  or 
floor.  Between  the  sole  of  the  feet  and  the  cast  a  thick  pad 

of  cotton  is  interposed  to  give 
cushion  support  to  the  foot.  Thick 
padding  is  necessary  also  around 
and  under  the  tibial  tuberosities. 
This  dressing  is  sometimes  used 
in  cases  of  delayed  union,  the 
theory  being  that  the  slight  mo- 
tion at  the  site  of  fracture  will 
stimulate  callus  formation. 

Segmented  or  Bracket  Casts 
fm  (Fig.  137). — When  it  is  desired 
to  have  access  to  wounds  of  joints 
or  wounds  extending  around  a 
large  part  of  the  circumference  of 
the  extremity,  the  part  is  bridged 
over  by  bands  of  metal,  the  ex- 
tremities of  which  are  incorpor- 
ated in  the  segments  of  plaster 
above  and  below.  Sufficient  curva- 
tion  is  given  the  strips  to  allow 
for  the  desired  ministrations  to 
the  parts. 

Plaster  Splints. — These  may 
be  made  from  plaster  bandages, 
folded  repeatedly  one  on  the  other,  and  applied  still 
wet  and  molded  to  the  part.  Cut  from  lint,  patterns  of  the 
splint  you  desire,  care  being  taken  that  the  lint  is  cut  so  that 
when  applied  on  each  side  of  the  limb  the  soft  side  is  next 
the  skin.  Make  the  pattern  slightly  larger  than  you  wish  the 


PIG.  137. — Segmented  or  bracketed 
cast. 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 


III 


splint.  The  pattern  can  be  made  more  accurately  by  taking 
measurements  of  one-half  the  circumference  of  the  limb, 
at  various  known  levels,  as,  for  example,  at  the  knee  and 
ankle,  in  leg  splints.  Lay  the  lint,  soft  side  down,  on  a  table 
and  then  apply  repeated  layers  of  plaster  bandage  and  wet 
plaster  until  the  desired  thickness  is  obtained  (Fig.  138). 
Usually  6  or  8  layers  are  sufficient.  Rather  than  make  the 
body  of  the  splint  with  layers  of  gauze  or  crinoline  bandage, 
one  may  use  two  or  three  layers  of  lint  cut  to  fit  pattern  and 
impregnated  with  the  plaster  cream.  These  are  laid  upon  the 


FIG.  138. — Making  plaster-of -Paris  splint. 

corresponding  patterns  and  the  splints  are  completed  (Fig. 
139).  The  splint  is  now  applied  to  the  part,  the  plaster  side 
out,  and  bound  snugly  in  place  with  a  gauze  bandage  (Fig. 
140).  A  second  splint,  made  in  similar  manner,  is  applied 
to  the  opposite  side  and  bound  in  position  with  a  gauze  band- 
age. At  these  places  where  the  splint  must  be  molded  to 
sudden  change  in  shape  or  diameter,  a  dart  is  made,  after 
first  cutting  in  the  splint  edge  for  one  to  two  inches.  In  most 
cases  two  splints  are  desirable  (Fig.  141).  Each  should  be 
broad  enough  to  encircle  nearly  one-half  the  limb.  They  are 
especially  applicable  for  the  leg  and  forearm  and  are  held  in 
place  by  a  circular  plaster  strip,  by  adhesive  straps  or  by 
roller  bandage.  Plaster  splints  thus  used  have  many  ad- 
vantages over  the  older  circular  "  cast."  A  nurse  can  be 


112 


PRACTICAL  BANDAGING 


making  it  while  the  doctor  is  busy  at  other  parts  of  the 
dressing.  It  is  very  convenient  for  removal  (Fig.  142)  and 
inspection  of  the  parts  without  disturbing  the  position,  as 
one  or  the  other  splint  may  be  lifted.  By  having  only  one 


FIG.  139. — Making  a  plaster  splint  of  flannel. 

of  the  splints  take  in  one  joint  and  the  other  take  in  the 

other  joint  on  each  side  of  the  fracture,  by  alternate  removal, 

the  freed  joint  can  be  given  massage  and  passive  movement. 

Barvarian  Splint — Suspend  the  limb  in  a  sufficiently  large 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

piece  of  lint  or  flannel.  Stitch  the  sides  together  down  the 
front  of  the  leg  and  around  under  the  foot.  Now  apply  a 
casing  of  plaster  cream  at  least  *4  incn  thick.  Over  this 
apply  a  flannel  layer.  When  dry,  trim  off  excess,  cut  stitches 


FIG.  140. — Plaster  splint. 
FlG.  141. — Moulding  and  binding  in  position. 

and  turn  back,  protecting  the  edge  with  leather  or  adhesive. 
The  dressing  is  retained  by  bandage,  straps  or  laces. 

Plaster  Jacket  (Figs.  143  and  144). — This  dressing  is  to 
be  applied  to  the  trunk  or  neck,  when  fixation  and  extension 


PRACTICAL  BANDAGING 


FIG.  142. — Plaster  splints  removed. 


FIG.   143. — Patient  suspended  for   appli- 
cation of  plaster-of-Paris  jacket. 


FIG.  144. — Plaster  jacket. 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

are  desired.  The  patient  is  partially  suspended  from  the 
ceiling,  or  tripod,  with  straps  under  occiput  and  chin  and  one 
under  each  axilla,  or  placed  prone  on  a  Bradford  frame.  A 
cylinder  of  stockinette  or  tricot,  twice  as  long  as  the  desired 
cast,  is  placed  over  the  part  to  be  jacketed,  and  holes  cut 
out  for  the  arms.  A  strip  of  gauze  bandage  is  placed  between 
this  and  the  skin  to  be  used  as  a  scratching  string.  A  ,pad 
of  gauze  or  a  folded  towel  y2  inch  thick  and  4  inches  square 
is  placed  on  the  lower  abdomen  as  a  dinner  pad.  Bony  promi- 
nences are  well  padded,  and  the  plaster  bandages,  3  inches  to 
6  inches  wide  are  applied,  in  ascending  and  descending  spirals, 
well  up  under  the  arms,  or  around  the  neck,  in  cervical  cases 
and  well  down  over  the  pelvis.  Additional  turns  may  be  made 
over  the  shoulders  and  ngure-of-8  turns  under  the  axilla. 
After  the  plaster  has  "  set  "  and  is  still  wet,  the  margins  are 
trimmed  out,  above  and  below,  and  the  stockinette  extremities 
pulled  back,  as  a  cuff  on  each  end,  and  sewed  together  thus 
enveloping  the  cast  outside  and  inside.  To  lighten  the  cast 
portions  of  it  may  be  cut  out  of  the  anterior  surface.  Re- 
move the  dinner  pad.  This  dressing  is  used  for  conditions 
of  the  vertebrae  demanding  fixation  and  extension,  such  as 
tuberculous  disease,  severe  sprains  and  dislocations. 

Plaster  Spica  of  the  Lower  Extremity  (Figs.  145  and 
146). — For  the  application  of  plaster  cast  to  the  pelvis  and 
thigh  use  may  be  made  of  the  hip  rest  or,  better,  the  Martin- 
Eliason  sling.  In  the  absence  of  hip  rest  or  sling  the  super- 
imposed fists  may  be  used  as  a  support.  The  parts  to  be 
enveloped  in  plaster  are  covered  with  tricot  hose,  or  sheet 
wadding,  with  abundant  padding  over  the  sacrum  and  an- 
terior superior  spines  and  a  dinner  pad  placed  on  the  lower 
abdomen.  Pad  the  back  of  the  knee  well  and  place  a  strip 
of  wadding  down  each  side  of  the  crest  of  the  shin.  Place 
the  canvas  slings  under  the  patient,  one  under  the  head, 
another  under  the  shoulder,  the  third  under  the  pelvis  and  the 


n6 


PRACTICAL  BANDAGING 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 


117 


u8 


PRACTICAL  BANDAGING 


fourth  to  hold  the  unaffected  lower  limb.  Slide  the  frame 
over  the  bed.  After  attaching  the  slings  to  their  respective 
pulleys,  the  patient  is  raised  from  the  bed.  Remove  the  bed 
and  apply  the  cast,  by  making  spica  turns  around  hips  and 
thigh,  incorporating  reinforcing  strips  across  the  groin. 
In  cases  of  fracture  in  the  upper  third  of  the  femur  it  is 


FIG.  147. — Plaster  shoulder  cap. 

best  to  encase  the  thorax  up  to  the  arm  pits,  both  thighs  and 
the  injured  leg  as  far  as  the  ankle,  placing  the  limb  in  the 
desired  position.  The  pelvic  sling  remains  in  the  cast. 

Plaster  Shoulder  Cap  (Fig  147). — With  the  arm  held  at 
the  patient's  side  and  a  triangle  pad  between  it  and  the  chest, 
envelop  the  whole  with  flannel  bandage  and  apply  several 
layers  of  plaster  bandages  passing  around  the  chest  and  arm 


PLASTER-OF-PARIS  OR  GYPSUM  BANDAGES 

and  over  the  shoulder  well  in  toward  the  base  of  the  neck. 
The  lowest  turns  should  pass  around  just  above  the  bend  of 
the  elbow.  Sling  the  arm  at  the  wrist. 

Although  this  is  the  most  rigid  cap  it  is  sometimes  irk- 
some because  of  the  chest  constriction.  If  such  is  the  case 
make  the  cap  to  come  only  to  the  midline  of  the  body  front 
and  back  and  incorporate  in  it  bandage  strips  or  webbing 
straps,  as  shown  in  Fig.  147. 

Sodium  Silicate  (Liquid  Glass) — Sodium  silicate  in  aque- 
ous solution  is  often  used  in  making  a  fixation  dressing.  Pre- 
pare the  solution  by  evaporating  25  per  cent,  and  adding 
gelatine,  a  drachm  to  the  pound.  Cover  the  part  to  be  dressed 
with  a  single  layer  of  gauze  bandage  and  paint  the  silicate 
directly  on  it  with  a  brush.  Then  apply  successive  layers  of 
bandage  and  silicate  until  the  desired  thickness  is  obtained. 
Usually  4  or  5  thicknesses  are  sufficient.  It  is  not  necessary 
to  apply  any  padding  beneath  the  dressing,  although  it  may 
be  used  if  the  skin  is  hairy. 

A  casing  made  with  silicate  has  many  advantages  over 
plaster.  It  is  less  trouble  to  apply  it,  is  lighter,  more  compact 
and,  weight  for  weight,  is  very  much  stronger  and  more  rigid. 
It  is  especially  useful  for  splinting  toes,  fingers  and  arms. 

Its  one  disadvantage  is  the  length  of  time  it  requires  to 
dry.  This  period  is  shortened  considerably  by  the  addition 
of  gelatine,  or  mastiche  added  in  small  quantities.  Stability, 
until  the  dressing  hardens,  is  lent  by  the  incorporation  of 
strips  of  card-board. 

This  dressing  is  readily  removed  by  cutting  with  bandage 
scissors  or  by  using  warm  water,  as  silicate  is  readily  soluble 
in  water,  but  not  in  alcohol  or  ether. 

Starch  Bandage — Make  a  cold  starch  solution  of  a 
creamy  consistency.  Heat  this  until  it  becomes  a  clear,  sticky 
fluid.  Dress  the  part  to  be  bandaged  with  a  flannel  bandage, 
or  sheet  wadding.  Making  use  of  a  previously  shrunken 


I20  PRACTICAL  BANDAGING 

gauze  or  crinoline  bandage,  immerse  it  in  the  starch  fluid 
until  it  is  well  saturated,  then  apply  as  you  would  a  plaster- 
of-Paris  bandage.  Probably  a  much  neater  way  is  to  apply 
the  bandage  dry  and  then  paint  it  with  the  liquid  starch.  As 
many  layers  as  desired  are  applied,  reen  forced,  if  necessary, 
by  strips  of  metal,  card-board,  etc. 

Care  must  be  taken  in  the  application  of  starch  dressing 
that  due  allowance  be  made  for  any  shrinkage  that  may  occur. 

The  two  objections  to  the  dressing  are  its  lack  of  strength 
and  the  long  time  it  takes  to  get  dry  and  hard,  24  to  36  hours 
usually  being  necessary. 


INDEX 


Abdomen,  86 
Achilles  tendon,  99 
Acromioclavicular  joint,  90 
Adhesive  dressings,  83-101 
laced,  92 

plaster,  De  La  Cour's,  83 
Janus,  83 
surgeon's,   83 
"  ZO  ",  83 
strap,  dumb-bell,  92 
suspensory,  100 
taped  (Montgomery  strap),  92 
Ambulatory  casts,  109 
Ankle,  95 
Anterior    figure-of-8   of    shoulder 

and  chest,  34 
pelvic  triangle,  76 
Application  of  plaster  cast,io3~io6 
Arm     and     forearm,     quadrangle 

bandage  or  sling  of,  62 
Auriculo-occipital  triangle,  67 

Back,  93 

Bandage,  Barton,  47 
of  buttock,  "T,"  59 
of    chin,    four-tailed,    60 
circular,  6 
circular  turns  of,  5 
crossed,  of  perineum,  31 
Davis,  41,  42 
Desault,  38-41 
of  ear,  "  T,"  58 
of  elastic  fabric,  81 
ending,  6 
of  eye,  "  T,"  57 
figure-of-8,    19,   22-25,   33,   34, 

38,  47 
four-tailed,  of  nose  and  upper 

lip,  60 
gauntlet,  12 
Gibson,  48 
of  groin,  "  T,"  59 
Mayor's,  74 

modification  of  Mayor's,  75 
monocle  or  crossed,  of  one  eye, 

53 

oblique  fixation  of,  5 
of  jaw,  49 


Bandage,    of   occiput,    quadrangle. 
61 

perineal  (Cunningham),  56 

perineal  "  T,"  55 

requisites  of,  5 

of  scalp,  "  T,"  57 

spica,  17,  31 

spiral,  6 

reverse,  7 

starch,  119,  120 

Velpeau    (modified),    42-46 

Dulles,  46 
Bandages,  demigauntlet,  12 

elastic,  2,  80-82 

handkerchief,  65 

how  to  roll,  3 

material  composing,    i 

method  of  holding,  4 

miscellaneous,  55-79 

plaster-of-Paris,    or    gypsum, 
102^-120 

preparation  of,  2 

purposes  of,  I 

rolled  by  hand,  4 
by  machine,  3 

roller,  1-54 

starting,  5 

tailed,  55 
Barton  bandage,  47 

modified,  48 
Bavarian  splint,  112 
Binder,  pelvic,  101 

Rose,  87 
Binocular  or  crossed  bandage  of 

both  eyes,  54 
Bitemporal  triangle,  66 
Brachiocervical    triangle     (a    and 

&),  71,  72 
Brachioscapular    triangle    (a    and 

b),  73,  74 

Breast,  suspensory  of,  34,  36 
Breasts,  figure-of-8  of  (Kiwisch), 

38 

suspensory  of  both,  37 

triangle  of,  71 
Buck's  extension,  stirrup  extension 

strap,  94 

Buttock,  "  T  "  bandage  of,  59 
121 


122 


INDEX 


Cap,  plaster  shoulder,  118 

Cast,  plaster,  application  of,  103- 

106 
method  of  removing,  106- 

108 

Casts,  ambulatory,  109 
fenestration  of,  108 
segmented  or  bracket,   no 
Catheter  straps,  92 
Chest,  96-98 

double  "  T  "  of,  59 
Chin,  four-tailed  bandage  of,  60 
Cone,   furuncle,  93 
Considerations,  general,  84-86,  102 
Cravats,  79 

Crinoline  or  tarlatan,  2 
Crossed  bandage  of  perineum,  31 

or  binocular,  of  both  eyes, 

54 
or   monocle,    of   one   eye, 

53 
Cunningham,  perineal  bandage,  56 

Davis  bandage,  41,  42 

De  La  Cour's  adhesive  plaster,  83 

Demigauntlet  bandages,  12 

Desault,   38-41 

Double  oblique  of  jaw,  50 

roller,  recurrent  of  scalp  with, 
52 

spica  of  groin,  29 

"  T  "  of  chest,  59 
Dressing,  inguinal,  99 

Sayre,  shoulder,  88 

Unna's,  81,  82 
Dressings,  adhesive,  83-101 
Dulles   (Velpeau  modified),  46 
Dumb-bell  adhesive  strap,  92 

Ear,  "  T  "  bandage  of,  58 
Elastic  bandage,  80-82 

fabric  bandage,  81 

webbing,  81 

Eye,  monocle  or  crossed  bandage 
of    one,    53 

"  T  "  bandage  of,  57 
Eyes,   both,    binocular   or   crossed 

bandage  of,  54 
Esmarch  tube  or  tourniquet,  81 

Fabric  bandage,  elastic,  81 
Fenestration  of  casts,  108 
Figure-of-8  of  breasts  (Kiwisch), 

38 
of  head  and  neck,  47 


Figure-of-8  of  leg,  22-25 

short  loop  method,  22 
long  loop  method,  25 
method-3,  25 

of    shoulder    and    back,    pos- 
terior,  33 

and  chest,  anterior,  34 
Finger,    ring,    10 
spiral  of,  10 

reverse  of,  10,  n 
Flannel,   2 
Foot,  spiral  of,  covering  heel,  19,  20 

triangle,    79 

Four-tailed  bandage  of  chin,  60 
of.nose  and  upper  lip,  60 
Fronto-occipital  triangle,  66 
Furuncle  cone,  93 

Gauntlet  bandage,  12 
Gauze,  2 

General  considerations,  84-86,  102 
Gibson  bandage,  48 
Gluteal  triangle,  78 
Groin,  "  T  "  bandage  of,  59 
Gypsum,  or  plaster-of-Paris  band- 
ages, 102-120 

Hand  triangle,  76 
Handkerchief   bandages,   65 
Hammock,  scrotal,  76 
Head  and  neck,  figure-of-8  of,  47 

square  cap  of,  68-70 

triangle  of,  67 

Inguinal   dressing,  99 

triangle,  78 
Isinglass  plaster,  84 

Jacket,  plaster,  113-115 
Janus  adhesive  plaster,  83 
Jaw,    double   oblique    of,    50 

oblique  of,  49 
Joint,   acromioclavicular,   90 

Kiwisch,  figurerof-8  of  breasts,  38 
Knee,  98 

triangle,  79 

Laced  adhesive,  92 

Leg,  98 

figure-of-8  of,  22-25 

short  loop  method,  22 
long  loop  method,  25 
method-3,  25 


INDEX 


123 


Lip,  upper,  and  nose,   four-tailed 

bandage  of,  60 

Liquid  glass,  sodium  silicate,  119 
Lower  extremity,  plaster  spica  of, 

115-118 

Many  tailed  bandages  (Scultetus), 

63 

Martin's  rubber  bandage,  80 
Mayor's  bandage,  76 

modification  of,  75 
Method  of  holding  bandages,  4 
of    removing    a    plaster    cast, 

106-108 

Miscellaneous  bandages*  55~79 
Modification  of  Mayor's  bandage, 

Modified  Barton,  48 

Velpeau    (Dulles),  46 
Monocle    or    crossed    bandage    of 

one    eye,    53 
Montgomery  strap,  taped  adhesive, 

92 

Neck  and  head,  figure-of-8  of,  47 

quadrangle  bandage  of,  61 
Nose    and    upper    lip,    four-tailed 
bandage  of,  60 

Oblique  of  jaw,  49 
double,  50 

Occipitofrontal   triangle,  66 
Occiput,    quadrangle    bandage   of, 
61 

Pelvic,   anterior,  triangle,  76 

binder,  101 

posterior,  triangle,  76 
Perineal  bandage   (Cunningham), 
56 

"  T  "  bandage,  55 
Plaster,   adhesive,   De   La   Cour's, 

83 

casts,  applications  of,  103-100 
method  of  removing,  106- 

108 

isinglass,  84 
jacket,    113-115 
Janus   adhesive,  83 
shoulder  cap,  118 
spica  of  lower  extremity,  115- 

118 

splints,  IIO-H2 
surgeon's  adhesive,  83 
"  ZO  "  adhesive,  83 


Plaster-of-Paris  or  gypsum  band- 
ages, 102-120 
Posterior  figure-of-8  of  shoulders 

and  back,  33 
pelvic  triangle,  76 
triangle  of  shoulders,  70 

Quadrangle  bandage  of  neck,  61 
of  occiput,  61 
of  vertex,  61 
or  sling  of  arm  and  fore- 
arm,  62 
of  shoulder,  61 

Recurrent  of  scalp,  51 
transverse,    52 
with  double  roller,  52 
Requisites  of  bandage,  5 
Roller  bandages,    1-54 

double,      recurrent      of    scalp 

with,  52 
Rose  binder,  87 
Rubber  bandage,  Martin's,  80 

Sayre  dressing,  shoulder,  88 

modified,  89 
Scalp,  recurrent  of,  51 

with  double  roller,  52 

"  T  "  bandage  of,  57 

transverse   recurrent  of,   52 
Scrotal  hammock,  76 

square,  78 

triangle,  78 
Scultetus,    many   tailed    bandages, 

63 

Segmented  or  bracket  casts,   no 
Shoulder  cap,  plaster,  118 

quadrangle   bandage   or    sling 

of,  61 

Sayre  dressing,  88 
triangle,  75 
Shoulders,    posterior    triangle    of, 

70 

Silicate,  sodium  (liquid  glass),  119 
Sling,  tibiocervical,  78 
Sodium  silicate  (liquid  glass),  119 
Spica  of  foot,  21 
of  groin,  25-29 
of    lower    extremity,    plaster, 

115-118 

of  shoulder,  16 
of  thumb,  ascending,  13,  15 
descending,  13,  15 


124 


INDEX 


Spiral  of   foot  covering  heel,   19, 

20 
reverse  of  upper  extremity,  14, 

15 
of  lower  extremity,  17,  18, 

22 

Splint,   Bavarian,   112 
Splints,  93 

plaster,   110-112 
Square  cap  of  head,  68-70 

scrotal,  78 

Starch  bandage,    119,   120 
Starting  bandages,  5 
Stirrup    extension    strap    (Buck's 

extension),  94 

Strap    (Buck's  extension),  94 
dumb-bell  adhesive,  92 
Montgomery,   taped   adhesive, 

92 

Straps,  catheter,  92 
Surgeon's  adhesive  plaster,  83 
Suspensory,  adhesive,  100 
of  breast,  34,  36 
of  both  breasts,  37 
triangle,  of  breasts,  71 
Swathes,  63-65 

Tailed  bandages,  55 

Taped      adhesive       (Montgomery 

strap),  92 
"  T  "  bandage  of  buttock,  59 

of  ear,  58 

of  eye,  57 

of  groin,  59 

of  scalp,  57 
Testicles,  100 

Thoracicohumeral  triangle,  71 
Thoracicoscapular  triangle,  70 
Tibiocervical  sling,  78 
Tourniquet,  79,  81 
Transverse  recurrent  of  scalp,  52 
Triangle,  anterior  pelvic,  76 
auriculo-occipital,  67 
bitemporal,    66 


Triangle,   brachiocervical    (a   and 

b),  71,  72 
brachioscapular  (a  and  b),  73, 

x   74 

foot,   79 

fronto-occipital,   66 

gluteal,  78 

hand,   76 

of  head,  67 

inguinal,  78 

knee,  79 

occipitofrontal,  66 

posterior  pelvic,  76 

scrotal,  78 

shoulder,  75 

of  shoulders,  posterior,  70 

suspensory  of  breasts,  71 

thoracicohumeral,  71 

thoracicoscapular,   70 

verticomental,  66 
Tube  or  tourniquet,  Esmarch,  81 
Turns,  circular,  9,    16,   17,   19,  21, 

25,  28,  29,  34,  35,  37,  42,  46 
Turns,   figure-of-8,    9,    15,    16,    17, 
25,  36,  38,  47 

fundamental,  6 

horizontal,  31,  35,  37,  43,  44 

oblique,  35 

recurrent,  9 

spiral,  38,  39 

or  spiral  reverse,  19 

vertical,  43,  44 

Umbilicus,   87 

Unna's  dressing,  81,  82 

Velpeau   (modified),  42-46 

Dulles,  46 

Vertex,  quadrangle  bandage  of,  61 
Verticomental  triangle,  66 

Webbing,  elastic,  81 

"  ZO  "  adhesive  plaster,  83 


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